Senior Medical Claims Representative


Glastonbury, CT

Industry: Misc. Healthcare


5 - 7 years

Posted 405 days ago

  by    Sandy Carbonaro

This job is no longer available.

We are seeking a Senior Claims Representative to handle a caseload of claims and support the operations of the Claim Department and company. The primary responsibilities of the position are to investigate, evaluate and resolve medical malpractice claims brought against the company’s insureds. The position requires handling claims across varied medical specialties that present the greatest severity and complexity in the department. The position also requires providing support to the Loss Prevention, Underwriting, Finance, and Business Development departments.

Job Duties:


• Claim Handling

• Intake of first reports from insureds and their staff

• Identifying and analyzing coverage issues

• Selecting defense counsel

• Obtaining relevant medical records and coordinating the initial consultation with the insured and defense counsel

• Consulting with defense medical experts

• Litigation management including ongoing communication with defense counsel, monitoring of legal status reporting and reviewing billing practices

• Attending depositions of parties and experts, court conferences, mediations and trials

• Internal reporting and documentation of claim developments

• Preparing claim status reports for reinsurers

• Regular communication with the insured from initial meeting to claim resolution

• Presenting claims at internal claim roundtables

• Participation in medical panel claim review meetings

• Formulating and executing claim resolution plans

• Direct handling of settlement negotiations with plaintiff’s counsel

• Promptly paying all claim expenses and indemnity obligations and reporting claim outcomes to state and federal regulatory agencies

Additional Duties:

• Maintaining current knowledge of relevant legal decisions, claim trends and industry practices

• Maximizing productivity and claim results through use of technology

• Enhancing the team environment in Claim Department through collaboration with other claim personnel

• Support of Company Operations

• Assisting efforts to compile and analyze claim data

• Periodic attendance at company functions including Loss Prevention and Business Development events

• Providing feedback on and supporting implementation of corporate initiatives and IT projects

• Informing Underwriting Department of claim developments with potential underwriting implications

Required Skills and Qualifications:

• Bachelor of Arts or Science Degree (JDDegree is preferred)

• 5-7years of experience in casualty insurance claim handling, preferably within the medical malpractice field in CT and/or MA

• Ability to meet deadlines while managing an active and diverse caseload

• Strong interpersonal, written and verbal communication skills

• Ability to manage work outside the office including depositions, meetings with insureds and defense counsel, court conferences, mediations and trials.