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Claims Specialist

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Date: Jan 11, 2019

Location: MI, US

Company: The Doctors Management Company

    

Claims Specialist

The Doctors Company is seeking an experienced Claims Specialist in the state of Michigan. 

 

Claims Investigation/ Analysis

a.    Completes initial coverage analysis and requests input from supervisor before referral to counsel 
b.    Provides timely analysis of cases and reserve recommendations to supervisor so  appropriate reserves can be established
c.    Develops  a plan of action on  assigned cases in conjunction with defense counsel and supervisor 
d.    Makes appropriate recommendations to assist in  establishing a plan of action on all cases assigned to the team
e.    Conducts informed consent discussion
f.     Ensures timely referral on all high exposure cases to both the supervisor and regional leadership 
g.    Analyzes coverage upon assignment, consults with underwriting and refers to supervisor prior to referring the matter to general counsel
h.   Interview insured within performance standards/guidelines
i.    Obtains necessary medical records
j.    Retains medical consultant/expert (as needed) and completes the review process
k.   Consults with external stakeholders (insured, claimant, defense attorney, plaintiff attorney) to optimize results of the overall investigation and discovery process
l.    Interfaces with insured member to provide ongoing support and disclosure of investigation results to keep the member fully informed
m.  Confers with supervisor for development of a cohesive plan of action on each claim file
 

Litigation Management & Claims Resolution

a.   Makes recommendation for assignment of litigated matters to appropriate  defense panel members based on ability and experience 
b.   Partners with defense counsel for optimum outcome on all assigned cases
c.   Monitors  and approves fees and expenses within authority to comply with company guidelines and state statutory guidelines
d.   Evaluates attorney work product/performance and advises  supervisor of any need for corrective action or improvement
e.   Recommends the proper course of resolution to regional leadership based on the  investigation and discovery 
f.    Attends mediations, settlement conferences, arbitrations, and trials as necessary
 

Claims Guidelines (Reserve Management, File Documentation Management)

a.   Provides risk/benefit analysis  to the insured  while maintaining compliance with state laws, company guidelines and professional and ethical standards
b.   Understands 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 supervisor
c.   Understands settlement vs. jury verdict range value within the assigned venue and can articulate this to management
d.   Uses system tools to keep track of proper reserving time frames for all assigned cases
e.   Works with both management and outside stakeholders to document and explain rationale for reserves
f.    Documents all activities and investigation appropriately within the claim file
g.   Identifies & elevates ERM exposure 
h.   Consults supervisor as necessary and documents the file appropriately

 

Internal/ External Customer Support

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

Member Service

a.    Explains the claim service and/or litigation process
b.    Provides regular communication regarding claim development
c.    Supports the member throughout the life of the claim file up to and through trial (when applicable)
d.    Actively seeks out both the member and entity to ensure open lines of communication  with all company departments are maintained
e.    Elevates concerns expressed by the insured member to management as necessary

 

Other Duties to be Assigned

a.   Makes oneself available for any and all duties
b.   Accepts delegated tasks readily and completes assigned duties as directed

 

Education (and/or equivalent experience).

Bachelor’s degree or equivalent combination of education and experience required.

Juris Doctorate preferred.

Three to five (3-5) years of medical malpractice or equivalent claims-related experience preferred. 

 

Benefits:

We offer competitive compensation, incentive bonus plans, outstanding career opportunities, an exceptional work environment, and an impressive benefits package, which starts with medical, family and bereavement leave; same-sex domestic partner benefits; short- and long-term disability programs; and an employee assistance program. There's more:

  • Health, dental, and vision insurance
  • Health and dependent care tax-free spending accounts with a company match
  • 401(k) and Roth IRA with company match, as well as catch-up plans for both
  • 10 paid vacation days, 6 paid sick days, and 6 paid personal days each calendar year (with vacation increases based on length of service)
  • 10 paid holidays each calendar year
  • Life and travel insurance
  • Tax-free commuter benefits
  • In-person and online learning opportunities
  • Cross-function career opportunities
  • Business casual work environment
  • Time off to volunteer
  • Matching donations to qualifying nonprofit organizations
  • Company-sponsored participation at non-profit events

 

Overview:

At The Doctors Company, we are fiercely committed to our mission of advancing, protecting, and rewarding the practice of good medicine. Our employees are integral to our success as the nation’s largest physician-owned medical malpractice insurer—and reflect our core values of service and professionalism. Employees also make a difference in their communities through volunteer work and donations. In the last five years, employees have worked more than 5,000 hours for local community organizations and donated more than $500,000, in conjunction with a company matching funds program.

The Doctors Company is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.

 


Job Segment: Underwriter, Law, Claims, Medical, Healthcare Consultant, Insurance, Legal, Healthcare

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