Senior Medical Claims Adjuster
CHG Healthcare
full-time
Posted on:
Location Type: Remote
Location: Utah • United States
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Salary
💰 $92,900 - $179,700 per year
Job Level
About the role
- Responsible for managing medical professional liability claims.
- Managing data concerning medical professional liability claims within a database.
- Interacting with medical providers.
- Managing external counsel.
- Traveling (when necessary) to attend mediations, depositions, and trials.
- Negotiating and settling medical professional liability claims and lawsuits within established settlement authority.
- Document disciplinary actions, incidents, claims, and lawsuits concerning medical professional liability.
- Determine whether a covered claim has been made under the terms and conditions of a relevant policy of insurance and maintain a working knowledge of insurance policy forms to verify coverage.
- Establish, monitor, and authorize changes to indemnity and expense reserves on assigned claim files.
- Assign claim files to and supervise outside defense counsel, adjusters, and investigators and/or monitor medical professional liability claims being handled by an insurance company under an insured program.
- Evaluate liability and exposure in assigned claim files.
- Establish and proactively manage appropriate claim resolution, including formation and implementation of resolution strategy.
- Identify responsive documents and witnesses to properly evaluate incidents, claims, and lawsuits.
- Participate in periodic claim reviews with leadership.
- Independently manage incidents, claims, and lawsuits, including attending mediations and trials as necessary.
- Provide updates and recommendations on strategy for resolving incidents, claims and lawsuits to Sr. Leadership.
- Maintaining professional standards, conducting difficult conversations constructively, and modeling ethical conduct.
- Experience in building trust through transparency, ethical decision-making, and consistent leadership.
- Mentoring team development and fostering a positive culture.
- Ability to provide feedback, leadership presence, and relationship-building capabilities.
Requirements
- 5+ years of medical professional liability management experience.
- Multi-state experience adjusting medical professional liability claims.
- Willingness and ability to travel (nationally).
- Demonstrated track record of building high-performing teams through establishing trust, maintaining professional standards, and developing talent.
- Experience managing difficult conversations, providing corrective feedback, and addressing performance issues in a constructive and professional manner.
- Familiarity with claims management systems (preferably Assure Claims).
- Working knowledge of Microsoft Excel (pivot tables, lookups, indexes, etc.).
- Sound understanding of claim reserving process and loss runs.
- Strong interpersonal and communication skills with demonstrated ability to build trust and credibility with team members, providers, counsel, and leadership.
- Proven ability to provide constructive feedback and coaching in a professional, supportive manner that promotes growth and accountability.
- Leadership presence and sound judgment in managing sensitive personnel matters and maintaining confidentiality.
- Ability to develop and maintain productive working relationships based on mutual respect, transparency, and ethical conduct.
Benefits
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Applicant Tracking System Keywords
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Hard Skills & Tools
medical professional liability claims managementclaims management systemsclaim reserving processdata managementnegotiationsettlement authorityliability evaluationincident documentationMicrosoft Excelmulti-state claims adjustment
Soft Skills
interpersonal skillscommunication skillsleadership presencetrust buildingethical decision-makingmentoringconstructive feedbackrelationship buildingteam developmentconfidentiality