[Hiring] Senior Claims Consultant @Physicians Insurance A Mutual Company

Role Description

This Senior Claims Consultant independently manages complex medical professional liability claims across multiple jurisdictions, exercising sound judgement in investigation, exposure evaluation, reserving, litigation management, and resolution. The successful candidate takes ownership of an assigned caseload, develops and executes proactive claim strategies, critically evaluates defense counsel's recommendations, and provides clear, well supported recommendations to management. This role combines technical expertise, disciplined follow-through, and responsive, high touch service to our Members.

Qualifications

• Bachelor's degree or equivalent experience.
• Multi-state adjuster's licenses preferred or ability to procure as requested.
• Five plus years of professional medical liability including hospital professional liability claims experience with strong knowledge of claim evaluation, litigation management, coverage, reserving, negotiation, settlement strategy, and regulatory requirements.
• Demonstrated ability to independently assess complex claims, develop supported recommendations, manage competing priorities, and follow through on commitments.
• Excellent interpersonal, verbal, and written communication skills. Ability to present effectively to large or small groups.
• Ability to travel as determined by location, needs of member, and/or Court requirements, as necessary. Travel destinations include the company office for in-person events twice a year.
• Strong commitment to customer service, quality, and working in a collaborative team environment.
• Demonstrated technical ability to work with Microsoft Office, ShareFile, and Adobe Acrobat Pro.

Requirements

• Independently manage complex medical professional liability claims from investigation through resolution, within delegated authority.
• Provide proactive personalized Member service through regular communications and meetings at key claim stages, including initial assessment, strategy development, depositions, expert reviews, mediations, and trials.
• Collaborate with internal departments, defense counsel, experts, and other insurers and respond promptly to broker inquiries, as necessary.
• Investigate claims through medical record review, expert consultation and evaluation of liability causation, damages, and venue.
• Develop and execute proactive claim strategies, identify priorities, and complete timely follow up.
• Direct defense counsel and critically evaluate litigation strategy, recommendations and progress, expenses, and progress.
• Establish and reassess reserves, documenting basis for exposure evaluations and changes.
• Develop settlement strategies, obtain necessary consent and authority, and negotiate resolutions.
• Identify and promptly escalate coverage concerns, significant exposure changes, settlement demands and critical deadlines.
• Maintain current concise file documentation explaining analysis, decisions, and next steps.
• Prepare clear reports and Claims Committee presentations with supported recommendations.
• Maintain responsive, collaborative relationships with Members, counsel, experts, other insurers, and co-defendants.

Benefits

• The salary range for this position is $97,200 to $156,200.
• This position is also eligible for an annual company bonus at an incentive target level of 10%.
• Comprehensive benefits program, including a generous retirement program and Paid Time Off.
• Exceptional hybrid work environment.
• Opportunity to work for an industry leader whose programs have a positive impact on insurance and healthcare.