[Hiring] Senior Claim Specialist @Crawford & Company

Role Description

The Senior Medical Malpractice Claim Specialist is responsible for the independent investigation, evaluation, management, negotiation, and resolution of complex and high-severity medical malpractice and healthcare professional liability claims. The position will manage a diverse portfolio of litigated and non-litigated matters involving hospitals and health systems, long-term care and senior living organizations, physician and medical groups, and allied healthcare professionals and facilities.

This role requires significant medical malpractice claims expertise, strong technical judgment, and the ability to develop and execute effective claim and litigation strategies. The Senior Medical Malpractice Claim Specialist will work closely with clients, insureds, defense counsel, medical experts, brokers, carriers, and other stakeholders to achieve high-quality claim outcomes while delivering exceptional client service.

Qualifications

• Bachelor’s degree or equivalent combination of education and relevant professional experience.
• Juris Doctor (JD), Registered Nurse (RN), or other relevant legal or clinical background combined with significant claims experience preferred.
• Minimum of 7 years of progressively responsible medical malpractice, healthcare professional liability, or complex liability claims experience, with demonstrated responsibility for managing claims from initial notice through resolution.
• 10+ years of medical malpractice or healthcare professional liability claims experience preferred.
• Significant experience handling complex, litigated, and moderate-to-high-severity medical malpractice or healthcare professional liability claims.
• Demonstrated experience directing defense counsel, developing litigation strategy, evaluating liability and damages, establishing reserves, and negotiating complex settlements.
• Experience handling claims involving hospitals and health systems, long-term care, skilled nursing, assisted living, and senior living organizations, physician and medical groups, and allied healthcare professionals and facilities preferred.
• Experience managing high-severity claims involving catastrophic injury, wrongful death, significant permanent impairment, or substantial economic damages preferred.
• Experience working within a carrier, TPA, self-insured healthcare organization, captive, risk retention group, or other alternative-risk structure preferred.
• Strong knowledge of medical malpractice and healthcare professional liability claims, including standard-of-care, causation, damages, and medical-record analysis.
• Strong understanding of insurance coverage, policy interpretation, reserving principles, litigation management, and claim resolution strategies.
• Demonstrated ability to independently analyze complex medical, legal, and factual issues and make well-supported claim decisions.
• Excellent written and verbal communication skills, including the ability to prepare concise and persuasive claim evaluations, large-loss reports, reserve recommendations, and settlement authority requests.
• Strong negotiation, analytical, organizational, and client relationship skills.
• Ability to manage multiple complex matters and competing priorities while maintaining high standards for quality, responsiveness, and documentation.
• Must possess or be able to obtain and maintain required insurance adjuster licenses.
• Professional insurance designation such as CPCU, AIC, ARM, or equivalent preferred.

Requirements

• Independently manage a portfolio of complex and high-severity medical malpractice and healthcare professional liability claims from initial notice through final resolution.
• Handle claims involving hospitals and health systems, long-term care and senior living facilities, physician and medical groups, allied healthcare providers, and other healthcare organizations and professionals.
• Conduct comprehensive claim investigations, including review and analysis of medical records, incident reports, facility documentation, policies and procedures, witness information, pleadings, discovery, depositions, expert reports, and other relevant materials.
• Evaluate liability, damages, causation, standard of care, venue, jurisdictional considerations, and other factors affecting claim exposure.
• Identify significant severity drivers, emerging exposures, potential excess or reinsurance implications, and other issues requiring escalation or enhanced oversight.
• Develop, document, and execute proactive claim strategies designed to achieve timely, appropriate, and cost-effective resolutions.
• Direct and actively manage defense counsel throughout the litigation process, including development of defense strategy, discovery, depositions, expert selection, dispositive motions, mediation, settlement negotiations, and trial preparation.
• Partner with defense counsel and medical experts to evaluate standard of care, causation, damages, liability, and potential verdict exposure.
• Establish clear litigation objectives and ensure defense strategies remain aligned with the interests of the client, insured, and applicable carrier.
• Monitor defense counsel performance, litigation budgets, legal expenses, and case progression to ensure effective and efficient claim management.
• Participate in mediations, settlement conferences, strategy meetings, significant depositions, and trials as appropriate.
• Evaluate litigation developments and adjust claim strategy, reserves, and resolution plans as circumstances change.
• Establish and maintain timely, accurate, and well-supported reserves based upon comprehensive evaluation of liability, damages, medical issues, venue, litigation posture, and potential outcomes.
• Prepare clear and persuasive claim evaluations, exposure analyses, reserve recommendations, settlement authority requests, and large-loss reports.
• Develop and execute negotiation and resolution strategies for complex and high-severity claims.
• Negotiate settlements within assigned authority and make well-supported recommendations when additional authority is required.
• Identify appropriate opportunities for early resolution, mediation, alternative dispute resolution, or continued defense.
• Maintain comprehensive and timely claim documentation supporting key decisions, evaluations, reserves, and strategies.
• Review and interpret applicable insurance policies, endorsements, coverage provisions, retentions, deductibles, and other contractual requirements.
• Identify potential coverage issues and coordinate with coverage counsel, carriers, and other stakeholders as appropriate.
• Recognize and appropriately escalate claims involving excess exposure, reinsurance considerations, aggregation issues, coverage concerns, or other significant risk considerations.
• Identify trends and recurring loss drivers that may provide meaningful insights to clients, risk management teams, carriers, and other business partners.
• Serve as a senior technical claim resource and trusted partner to clients and insureds on complex medical malpractice matters.
• Maintain proactive, clear, and timely communication regarding claim developments, exposure, strategy, reserves, and resolution.
• Collaborate effectively with hospital and healthcare risk managers, senior living administrators, physician groups, brokers, carriers, defense counsel, medical experts, nurse consultants, and other stakeholders.
• Participate in client claim reviews, stewardship meetings, large-loss discussions, and other presentations as required.
• Deliver a high level of responsiveness, professionalism, technical expertise, and service consistent with client expectations.
• Serve as a subject matter expert in medical malpractice and healthcare professional liability claims.
• Provide technical guidance, mentoring, and support to less experienced claim professionals as appropriate.
• Maintain current knowledge of medical malpractice law, healthcare liability trends, litigation developments, emerging claim exposures, and jurisdictional issues.
• Ensure claims are handled in accordance with applicable client instructions, company best practices, regulatory requirements, service standards, and quality expectations.
• Contribute to continuous improvement initiatives, best-practice development, technical training, and knowledge sharing within the Specialty Claims organization.

Benefits

• Competitive base pay.
• Bonus/Incentive Pay and other Performance-Based Rewards, if applicable.
• Medical, Dental and Vision Plans.
• Prescription Drugs.
• HSA, HRA, and FSA Accounts.
• Paid Holidays, Vacation and Sick Leave.
• 401(k) Retirement Plan.
• Tuition Assistance.
• Paid Parental Leave.
• Supplemental Health Benefits.
• Enhanced Mental Health Support.
• Virtual Physical Therapy.
• Caregiving Services.
• Life Assistance Program.