Job DescriptionAdventist Health Roseville is looking for Sr. Claims Examiner for Full-Time, Day. We are looking for great individual who can work onsite to our location in Roseville, CAJob Summary:
Analyzes complex and/or technically challenging medical malpractice/general liability claims and resolves complex and/or severe injury claims. Coordinates case management within established standards and industry best practices. Manages total claim costs while providing high levels of customer service. Receives assignments in the form of objectives and determines tactical approach, resources, schedules and goals.
Job Requirements:
Education and Work Experience:
- Bachelor's degree or equivalent combination of education/related experience: Required
- Master's Degree or Juris Doctor: Preferred
- Seven years' liability claims management experience: Preferred
- One year's leadership experience: Preferred
- Experience with legal matters and complex litigation: Preferred
Essential Functions:
- Analyzes nature and extent of investigation necessary to evaluate liability and damages. Determines the need for and retains experts to evaluate the standard of care/damages. Develops, updates and executes case specific investigation plan and negotiates settlement of the claim. Applies advanced technical knowledge to solve complex problems for a department.
- Coordinates legal defense by assigning counsel, coordinates support for investigation. Reviews attorney invoices and monitors counsel for compliance with organization policies and guidelines.
- Calculates and assigns timely and appropriate reserves for claims. Monitors reserve adequacy throughout the life of the claim.
- Recommends and implements settlement strategies. Involves structured settlement professionals as necessary to maximize settlement and identifies opportunities for subrogation, contribution, recovery and other case management opportunities to mitigate total claim costs.
- Ensures claim file documentation is timely and accurate. Creates initial notice to reinsurers and provides timely updates on case status.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
