Medical Malpractice Claim Analyst
The James Allen Companies Inc.
Responsible for claim file investigation, evaluation and resolution following the claims handling guidelines.
Essential Duties & Responsibilities:
- Follow claims handling guidelines for all facets of claims handling, including but not limited to, claims documentation, diary, reserve adequacy, data entry, electronic filing of correspondence, coverage investigation, participation in case strategy round tables with claims management and/or defense counsel, case settlement, trial management, timely file closure, regulatory compliance, adherence to executive management escalation protocols, and adherence to Watch List and Event Calendar notification protocols.
- Maintain data integrity and accuracy in all aspects of claims handling.
- Demonstrate effective teamwork, provide positive morale and support for colleagues within the department.
- Continually seek opportunities to increase individual knowledge base and skills.
- Attend all mandatory training sessions.
- Seek additional training/educational opportunities.
- Participate in departmental projects.
- Continually evaluate the claim process and assist in developing process strategy with a goal of improving process efficiency.
- Maintain regular and prompt communication with all external and internal business partners.
- Author and proofread required management reports for accuracy, grammar, and relevant information.
- Facilitate claim expense management to include invoice and proposed defense budget reviews; ensure accurate Indemnity and ALAE reserving; negotiate claim settlements within approved settlement authority; and closely monitor defense counsel settlement negotiations and trial events on all claim files.
- Maintain appropriate open/close ratio.
- Other duties as assigned
Education & Qualifications:
- 3+ years of prior experience in the medical liability insurance industry preferred. Analyst qualifications will be based on performance and years of experience in the field.
- Ability to function with minimal supervision.
- Must achieve an overall rating of 3.5 or higher on last two performance evaluations at current level to advance to the next level.
- Consistently demonstrate sound judgment and thorough claims management in present position.
- Must be detail oriented and have good organizational skills.
- Excellent oral and written communication skills required.
- Ability to function in a professional office environment and utilize standard office equipment.
- Must demonstrate ability to maintain an effective working relationship with other departments, employees, management and clients.
- Prior experience working with Microsoft Word. Must demonstrate the willingness and ability to learn a variety of additional computer programs, i.e. Excel, PowerPoint, e-Oasis, and OnBase.