TDCSU is currently seeking a Senior Claims Specialist to handle primary and excess managed care claims that involve moderate and potentially significant severity and complexity.
Working under the general supervision of VP of Claims and acting within authority appropriate to this position, the Senior Claims Specialist role is composed of the following responsibilities:
Investigate, evaluate and resolve claims with strong technical knowledge in managed care. The Senior Claims Specialist role is expected to independently and pro-actively manage managed care claims and establish a plan of action to achieve a favorable claim resolution. The Senior Claim Specialist is expected to demonstrate proficiency in the following:
- Identifying and analyzing coverage issues
- Negotiating claim settlement within authority level
- Reviews files for timely and appropriate reserves; monitors reserve adequacy throughout the life of a claim file
- Selects defense counsel within authority
- Manages litigation process including ongoing communication with defense counsel, monitoring of legal status reporting, reviewing invoices and ensuring compliance with litigation guidelines
- Attends mediations, court conferences and trials
- Regularly communicates with the insured from initial contact to claim resolution
- Regularly communicates with outside counsel as appropriate
- Formulates and executes claim resolution plans
- Promptly pays all claim expenses and indemnity obligations including the reporting of claim outcomes to state and federal regulatory agencies
- Presents claims at internal claim roundtables
- Prepares claim status reports to reinsurers
- Regularly reviews quarterly loss runs for increase in reserves or severity matters, alerting management for potential impact to the TDCSU policies
- Engages in collaborative projects in support of other areas in the company.
- The position also requires providing support to our Segment Leaders and Business Development Department. Attends marketing calls. Actively participates in pre-bind calls and visits with insureds and broker
Preferred Candidates
Should possess strong knowledge of relevant legal decisions, claim trends and industry practices. Strong technical knowledge in managed care claims. Additionally, it is important that the candidate have a demonstrated track record for professional commitment, curiosity, resourcefulness and a focus on tenaciously achieving outcomes that support our key business objectives.
Requirements
Possess strong knowledge of the legal system, litigation, claims trends, and industry practices.
Superior Communication and customer relations skills.
Bachelor's Degree or equivalent combination of education and experience required.
Three to five (3-5) years of managed care or equivalent claims-related experience.
Proficiency with Excel, Word and demonstrated aptitude with Windows based operating systems
