Claims Consultant

Claims Consultant - Liability Professional | Med Mal | General ql Work Location: Must reside in the State of Louisiana. 100% remote or hybrid. Position Summary: This position is responsible for managing medical malpractice, general and auto liability claims, including the investigation, evaluation, reserving, negotiating, settlement and closure of assigned claims for well-known Louisiana based Insurance Carrier. Warm welcoming environment where executives encourage out the box thinking values client service and fosters career advancement and growth mindset. Qualifications Minimum of 5 years’ experience as a 'DESK ADJUSTER' handling Liability or Medical Malpractice claims or equivalent experience. Must reside in the State of Louisiana and have direct experience adjusting Louisiana claims as a W2 full adjuster at an insurance carrier. Enjoy interacting with Account Customers. Familiar with or serving hospital/healthcare clientele a plus. Possess keen ability to present in front of groups performing CEU’s and claims reviews as required. Possess professional demeanor / client-facing appearance. Enjoy working with dedicated accounts. Embrace a 'Client Retention' growth mindset. Proactive, continuous learner, well organized with a knack for process improvement. Company is very forward thinking so cultivates employees who bring new ideas and solutions to continuously improve customer/account experience. Possess Type A personality. Welcome candidates with Tier 1 2 Carrier backgrounds who can share claims’ handling experience and expertise with team. Possess proven tenured track record. Good communication and interpersonal skills with clients and staff. Good problem-solving, negotiating, and organizational skills. Good computer skills including experience with claims management software, etc. Must have professional home office. Able to work independently and collaborate with others. Ability to travel with flexibility within the State of LA as necessary. Ideal candidates will be considered for the opportunity to work a hybrid or remote location within the state of Louisiana. Essential Functions & Responsibilities Determine applicability of coverage for submitted claims, complaints, or suits in collaboration with the Underwriting Department. Coordinate, perform and complete investigations, including taking recorded statements, securing scene investigations, obtaining photographs and videos as appropriate. Assign defense counsel as appropriate. Evaluate claims, complaints, or suits through contact with clients, claimants, and medical providers in accordance with company guidelines, independently and in coordination with defense counsel. Identify and pursue all sources of 3rd party liability for recovery purposes. Obtain all medical records necessary to evaluate and establish liability and/or compensability in a timely manner. Evaluate and monitor liability and promptly set reserves based on company guidelines. Maintain updated diaries, fully document file notes and store documents pursuant to document retention guidelines utilizing network filing systems. Attend mediations, trials, and medical review panel meetings as appropriate. Coordinate and perform client claim review meetings, as appropriate. Timely report to reinsurance and excess carriers when claim file meets their reporting requirements. Negotiate and settle claims with claimants and/or their legal representative, in the most cost-effective manner ensuring timely issuance of disbursements within the related scope of authority. Maintain cost-effective control of various outside vendors providing claim related services. Assess education needs of clients and areas of loss control improvement in collaboration with Risk Management Department. Pursue continuing self-development and education. Follow established company policies and procedures. Maintain applicable HIPAA privacy standards for all claims. Aggressively manage the litigation process on all claims submitted to various law firms and assist counsel with defense of the claim/case. Perform other duties as needed. Reporting Relationships This position reports to the Vice President of Claims Operations. Seniority Level Mid-Senior level. Employment type Full-time. Job function Finance and Sales. Industry Insurance. #J-18808-Ljbffr