Position Description

Position Summary:

Investigates, evaluates, and manages the defense of claims to resolution. Negotiates settlements within delegated authority and handles claims to resolution. Functions as directing member of the defense team, which includes the insured and defense attorney.

Reporting Relationship:

Reports directly to the Vice President of Claims or Regional Claim Manager

Essential Functions/Responsibilities:

• Works in a cooperative manner with management, coworkers, customers, and vendors; seeks to support LAMMICO’s mission and vision in daily operations
• Contributes to the development of the department’s strategic and operating planning and meets assigned target dates and budget goals; helps ensure that department quality, service, and productivity standards are met
• Contacts and interviews insureds, witnesses and other involved parties to determine liability and exposure of the insured/client and the company; promptly completes face-to-face interviews with insureds; handles claims and brings them to resolution without a defense attorney when possible
• Sets and maintains adequate and accurate reserves within his/her authority, recommends reserves above his/her authority, confirms coverage and refers coverage issues to Vice President/Manager for resolution, when applicable; prepares case related reports and submissions to Claims Committee, initial medical review and/or management; interacts on a daily basis with insureds, defense and plaintiff attorneys, the Patient’s Compensation Fund and other health care providers, such as hospitals
• Negotiates and resolves claims within level of settlement authority; recommends settlement in claims exceeding individual authority and negotiates and resolves cases once authority approved
• Obtains signed consent to settle from insured and assures that all liens, including Medicare and Medicaid are satisfied
• Assists defense attorney in preparing cases for trial and attends trials
• Prepares various reports as required by department policies and procedures, including National Practitioner’s Data Bank, reports and updates to the Claims Committee and initial medical reviewers, settlement authority requests, trial memos, and reports for Underwriting/Joint Risk Assessment
• Assures accurate and timely claims data is entered into Oasis and ImageRight
• Maintains active/current diary in Oasis on all assigned claims in accordance with Claim Department objectives  
• Keeps tasks in ImageRight current in accordance with Claim Department objectives
• Attends and participates in Risk Management seminars and assists in marketing LAMMICO to physicians and other health care providers whenever possible

Secondary Functions/Responsibilities:

• Other responsibilities and special projects as assigned
• Assists in training support staff and newly hired claims personnel
• Performs tasks, special projects and claims related duties as assigned
• Attends seminars and training courses as required

Education, Experience and Skills

Required:

• Bachelor’s Degree 
• Minimum of four years of experience in insurance claims
• Maintain a current adjuster’s license for all states where he/she handles claims
• Strong customer focus and team orientation
• Ability to appropriately handle confidential or sensitive company information
• Commitment to continuing industry and individual functional education
• Excellent communications skills with the ability to interact and work effectively with employees at all levels within the organization
• Ability to manage time, set priorities, and work independently; ability to organize, analyze, and interpret information
• Proficiency in the use of Microsoft Office programs
• Experience with policy quoting, rating and issuance systems
• Must have continuous and uninterrupted access to reliable transportation; must maintain driver’s license and insurance as required by state

Desired:

• Minimum of two years in medical malpractice claims adjusting Insurance industry experience
• Working knowledge of coverage and principles, reinsurance and litigation practices
• Training/experience in negotiations and mediations