Medical Malpractice Adjuster

Senior Field Representative I / II – Medical Malpractice Claims

Position Overview

We are seeking an experienced Senior Field Representative to investigate, evaluate, manage, and resolve medical malpractice claims. This position may be filled at either the Senior Field Representative I or Senior Field Representative II level, depending on the candidate’s overall claims background and depth of medical malpractice experience.

While direct medical malpractice claims experience is preferred, the company is also open to exploring candidates from other complex claims backgrounds, including Bodily Injury, Personal Injury, and Workers’ Compensation, particularly those who have experience with litigation, attorneys, medical records, injury evaluation, negotiations, and claim resolution.

Candidates coming from a legal background, such as an experienced paralegal or litigation support professional, may also be considered if their experience translates well to claims investigation, case management, medical documentation, litigation coordination, and negotiation.

The Senior Field Representative manages claims from initial investigation through resolution and serves as a directing member of the defense team, working closely with insureds, defense counsel, claimants, plaintiff attorneys, healthcare providers, and other involved parties.

Key Responsibilities

• Investigate, evaluate, and manage assigned claims through resolution.
• Contact and interview insureds, witnesses, claimants, healthcare providers, and other involved parties to determine liability and potential exposure.
• Conduct timely face-to-face interviews with insureds when appropriate.
• Manage claims toward resolution without defense counsel when circumstances allow.
• Analyze coverage and refer complex coverage questions to claims leadership as appropriate.
• Establish and maintain accurate reserves within assigned authority and make recommendations when reserve needs exceed individual authority.
• Negotiate and resolve claims within delegated settlement authority.
• Prepare settlement recommendations and requests for additional authority on claims exceeding individual settlement authority.
• Coordinate closely with insureds, defense attorneys, plaintiff attorneys, healthcare providers, and other parties throughout the claims process.
• Obtain appropriate insured consent for settlements and ensure applicable liens, including Medicare and Medicaid liens, are addressed.
• Assist defense counsel with trial preparation and attend trials when necessary.
• Prepare claim reports, settlement authority requests, trial memoranda, committee updates, medical review submissions, and other required documentation.
• Maintain accurate and timely claim notes, diaries, documentation, and system activity.
• Participate in mediations, negotiations, and other claim resolution activities.
• Support risk management seminars and other educational or customer-facing initiatives as requested.
• Assist with the training and development of support staff and newly hired claims personnel.

Qualifications

Senior Field Representative I

• Bachelor’s degree required.
• Minimum of four years of insurance claims experience.
• Medical malpractice claims experience is preferred but not necessarily required.
• Candidates with strong experience in Bodily Injury, Personal Injury, Workers’ Compensation, complex casualty, or litigated claims may be considered.
• Legal professionals, including paralegals with relevant litigation, medical, or insurance-related experience, may also be considered.
• Current adjuster’s license for all states in which claims are handled, or ability to maintain required licensing.

The original Level I requirements call for a minimum of four years of insurance claims experience, with medical malpractice adjusting listed as preferred experience.

Senior Field Representative II

• Bachelor’s degree required.
• Minimum of four years of insurance claims experience.
• Ideally, at least two years of medical malpractice claims adjusting experience.
• Demonstrated experience managing complex claims involving litigation, attorneys, medical issues, settlement negotiations, and significant exposure.
• Candidates with especially strong transferable experience in complex bodily injury, personal injury, workers’ compensation, or litigation may also warrant consideration depending on the depth of their background.
• Current adjuster’s license for all states in which claims are handled, or ability to maintain required licensing.

The formal Level II description requires four years of insurance claims experience, including two years of medical malpractice claims adjusting.

Candidates may be hired at either Level I or Level II based on their overall claims experience, medical malpractice exposure, legal background, technical expertise, and demonstrated ability to independently manage complex matters.

Transferable Backgrounds of Interest

The company is open to considering professionals whose experience may translate effectively into medical malpractice claims, including:

• Bodily Injury Claims
• Personal Injury Claims
• Workers’ Compensation Claims
• Complex Casualty Claims
• Litigated Claims
• Legal or Litigation Support
• Paralegal experience
• Medical-related litigation or case management
• Claims involving attorneys, medical records, injury evaluation, negotiations, mediations, or settlements

Candidates do not necessarily need to come directly from medical malpractice if they bring the right combination of claims knowledge, litigation exposure, medical familiarity, investigative ability, and communication skills.

Additional Skills & Experience

• Strong understanding of claims handling and litigation practices.
• Knowledge of insurance coverage principles and reinsurance is beneficial.
• Experience with negotiations and mediations.
• Strong investigative, analytical, organizational, and decision-making skills.
• Excellent written and verbal communication skills.
• Ability to build productive relationships with insureds, attorneys, healthcare professionals, coworkers, and other business partners.
• Strong customer focus and team orientation.
• Ability to appropriately handle confidential and sensitive information.
• Ability to manage multiple priorities and work independently while collaborating effectively with others.
• Proficiency with Microsoft Office and claims management systems.
• Reliable transportation, valid driver’s license, and required automobile insurance.

Reporting Relationship

Reports to the Vice President of Claims or Regional Claims Manager.

Leveling

Level I: Appropriate for an experienced claims or legal professional who has strong transferable experience and the ability to grow into medical malpractice claims handling.

Level II: Appropriate for a more seasoned claims professional with direct medical malpractice experience or a highly comparable complex claims background who can independently manage more sophisticated claims through litigation and resolution.