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The Doctors Company
Napa, California, United States
4 days ago

Description

The Doctors Company is seeking an experienced Claims Specialist for our Region II (Northeast) team. This position will be a telecommuter role and the successful candidate can be located anywhere in our region but will have responsibility for claims in the states of Indiana, Kansas, Missouri and Michigan.

The Claims Specialist independently and pro-actively manages the medical malpractice claims for assigned members. Monitors and reviews all new claims for designated members and establishes a plan of action to achieve a favorable claim resolution. Attends and facilitates member meetings and claim reviews. Reviews and recommends appropriate case reserves.  Negotiates settlements when appropriate and attends trial and provides insights and analysis.  Advocates, consults, and serves as a trusted resource and partner with physician members.

Responsibilities:

  1. Completes initial coverage analysis
  2. Develops a plan of action on assigned cases in conjunction with defense counsel and supervisor 
  3. Interview insureds within performance standards/guidelines
  4. Consults with external stakeholders (insured, claimant, defense attorney, plaintiff attorney) to optimize results of the overall investigation and discovery process
  5. Interfaces with insured member to provide ongoing support and disclosure of investigation results to keep the member fully informed
  6. Makes recommendation for assignment of litigated matters to appropriate defense panel members
  7. Partners with defense counsel for optimum outcome on all assigned cases
  8. Monitors and approves fees and expenses within authority
  9. Evaluates facts, allegations, liability and damages issues and maintains appropriate case reserves
  10. Recommends the proper course of resolution to regional leadership based on the investigation and discovery 
  11. Attends mediations, settlement conferences, arbitrations, and trials as necessary
  12. Provides risk/benefit analysis to the member
  13.  Supports the member throughout the life of the claim file up to and through trial
  14. Other duties as assigned

Education (and/or equivalent experience) required.

  • Bachelor’s degree or equivalent combination of education and experience required.
  • Juris Doctorate preferred.
  • Three to five (3-5) years of medical malpractice or equivalent claims-related experience.
  • Prior claims experience in Indiana, Kansas, Missouri and Michigan is a plus.

Under TDC Group's COVID-19 Workplace Safety Policy, all vaccinated employees, including those temporarily working from home or designated as full-time telecommuters, will be required to show visual proof of vaccination. Employees who are not vaccinated, do not provide proof of vaccination, or have an approved exemption must submit a weekly negative COVID test starting the first shift working on or after December 6, 2021. If your position requires that you be vaccinated, for example working in medical environments that require immunization, weekly testing is not an option. Upon hire into a TDC Group position, you will be provided detailed instructions on how to comply with this policy including access to the COVID vaccination at no cost.



Job Information

  • Job ID: 59294422
  • Location:
    Napa, California, United States
    Remote, United States
  • Position Title: Claims Specialist
  • Company Name: The Doctors Company
  • Industry: Health/Medical/Managed Care
  • Job Function: Claims Administrator
  • Job Type: Full-Time

Please refer to the company's website or job descriptions to learn more about them.

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