Senior Claims Specialist, Miscellaneous Medical Facilities & Long-Term Care Professional Liability

Analyzes, investigates, and evaluates MMF/LTC Professional Liability Claims from first notice of loss through resolution he loss to determine coverage and claim disposition. Utilizes CMS to document claims and to diary future events or follow-up. Within prescribed settlement authority for the line of business, establishes appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Makes recommendations to set reserves at appropriate level for claims outside of authority level. Prepares comprehensive reports as required. Identifies and communicates specific claim trends and account and/or policy issues to management and underwriting. Manages the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment. Monitors the case resolution process. Actively participates in mediations and arbitrations, within limit of settlement authority. Participates in Claims audit process. May provide claims marketing services by participating in meetings with brokers, risk managers and reinsurers. As required, maintains insurance adjuster licenses. Bachelors' and/or advanced degree. JD is a plus, especially with experience litigating Professional Liability claims (MMF or LTC). 5+ years claims/legal experience, with substantive, hands-on Medical-related Professional Liability claims (Providers and/or facilities) Functional knowledge of claims handling Professional Liability concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge. Functional knowledge of law and insurance regulations in various jurisdictions common to Miscellaneous Medical Facilities and/or Long-Term Care Professional Liability. Proven analytical, negotiation and written/verbal communication skills; able to present complex clinical and coverage positions to Counsel, Underwriters, Senior Management, and other applicable parties.