Claims Specialist

The Doctors Company is seeking an experienced Claims Specialist in our Region III. This is a hybrid or remote opportunity depending on the final candidate’s location from the company's offices, with the preferred location of Georgia.

The Claims Specialist independently and pro-actively manages the medical malpractice claims for assigned members. Monitors and reviews all new claims for designated members and establishes a plan of action to achieve a favorable claim resolution. Attends and facilitates member meetings and claim reviews. Reviews and recommends appropriate case reserves. Negotiates settlements when appropriate and attends trial and provides insights and analysis. Advocates, consults, and serves as a trusted resource and partner with physician members.

Qualifications

Bachelor’s degree or equivalent combination of education and experience required. Juris Doctorate preferred.3 + years of medical malpractice or equivalent claims-related experience.

Salary Range: $$96,325 - $118,989

Responsibilities

Claims Investigation/ Analysis

Completes initial coverage analysis and requests input from supervisor before referral to counsel Provides timely analysis of cases and reserve recommendations to supervisor so appropriate reserves can be establishedDevelops a plan of action on assigned cases in conjunction with defense counsel and supervisor Makes appropriate recommendations to assist in establishing a plan of action on all cases assigned to the teamConducts informed consent discussionEnsures timely referral on all high exposure cases to both the supervisor and regional leadership Analyzes coverage upon assignment, consults with underwriting and refers to supervisor prior to referring the matter to general counselInterview insured within performance standards/guidelinesObtains necessary medical recordsRetains medical consultant/expert (as needed) and completes the review processConsults with external stakeholders (insured, claimant, defense attorney, plaintiff attorney) to optimize results of the overall investigation and discovery processInterfaces with insured member to provide ongoing support and disclosure of investigation results to keep the member fully informedConfers with supervisor for development of a cohesive plan of action on each claim file

Litigation Management & Claims Resolution

Makes recommendation for assignment of litigated matters to appropriate defense panel members based on ability and experience Partners with defense counsel for optimum outcome on all assigned casesMonitors and approves fees and expenses within authority to comply with company guidelines and state statutory guidelinesEvaluates attorney work product/performance and advises supervisor of any need for corrective action or improvementRecommends the proper course of resolution to regional leadership based on the investigation and discoveryAttends mediations, settlement conferences, arbitrations, and trials as necessary

Claims Guidelines (Reserve Management, File Documentation Management)

Provides risk/benefit analysis to the insured while maintaining compliance with state laws, company guidelines and professional and ethical standardsUnderstands the facts of each case, develops the full range of damages and applies the external factors to determine the exposure and makes the appropriate recommendation to their supervisorUnderstands settlement vs. jury verdict range value within the assigned venue and can articulate this to managementUses system tools to keep track of proper reserving time frames for all assigned casesWorks with both management and outside stakeholders to document and explain rationale for reservesDocuments all activities and investigation appropriately within the claim fileConsults supervisor as necessary and documents the file appropriately

Internal/ External Customer Support

Develops trust with stakeholders by making themselves available as necessary Gives information to stakeholders sufficient to enable them to make informed decisions

Member Service

Explains the claim service and/or litigation processProvides regular communication regarding claim developmentSupports the member throughout the life of the claim file up to and through trial (when applicable)Actively seeks out both the member and entity to ensure open lines of communication with all company departments are maintainedElevates concerns expressed by the insured member to management as necessary

Other Duties To Be Assigned

Makes oneself available for any and all dutiesAccepts delegated tasks readily and completes assigned duties as directed

About The Doctors Company

The Doctors Company is the nation’s largest physician-owned medical malpractice insurer. Founded and led by physicians, we are committed to advancing, protecting, and rewarding the practice of good medicine.

The Doctors Company is proud to be Certified™ by Great Place to Work®.