Complex Claims Consultant, Medical Malpractice and Dental

Responsibilities

• Manages an inventory of highly complex commercial claims
• Ensures exceptional customer service by managing all aspects of the claim
• Verifies coverage and establishes timely and adequate reserves
• Leads focused investigation to determine compensability, liability and covered damages
• Resolves claims by collaborating with internal and external business partners
• Establishes and manages claim budgets by achieving timely claim resolution
• Realizes and addresses subrogation/salvage opportunities or potential fraud occurrences
• Maintains subject matter expertise and ensures compliance with state/local regulatory requirements
• Mentors, guides, develops and delivers training to less experienced Claim Professionals

Requirements

• Bachelor's Degree or equivalent experience
• Typically a minimum six years of relevant experience, preferably in claim handling
• Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable
• Prior negotiation experience
• Professional designations preferred (e.g. CPCU)

Core Competencies

Demonstrates expertise in managing complex commercial claims, ensuring compliance with regulatory requirements, and delivering exceptional customer service. Proficient in negotiation, budget management, and mentoring less experienced claim professionals.