Claims Adjuster

Orlando Health•Orlando, FL

About The Position

The Claims Adjuster manages a caseload of third-party claims made against Orlando Health, focusing on medical professional and general liability claims. The role coordinates claim investigations and evaluations, develops strategies with Claims leadership and legal counsel, and uses claims management and loss-reduction techniques to negotiate and settle claims. The adjuster also supports legal proceedings, handles Department of Health licensure investigations, maintains claim documentation and reports, and works with other departments on insurance-related activities.

Requirements

Five years of clinical, medical-legal, or claims adjusting experience.

Nice To Haves

Bachelor’s degree in healthcare is preferred.

Responsibilities

Identify actual and potential third-party claims, primarily professional and general liability claims, and potentially property, auto, and other claims.
Coordinate complete investigations and evaluations of assigned claims and work with legal counsel and Claims leadership on strategies to resolve or defend them.
Use claims management and loss-reduction techniques to negotiate and settle claims that can be resolved without legal counsel.
Participate in setting initial reserves and recommend reserve changes in coordination with Claims leadership.
Establish and maintain claim files with detailed documentation of significant activity and correspondence with legal counsel and insurance carriers.
Serve as a liaison among Orlando Health team members, physicians, and assigned legal counsel from claim initiation through settlement or trial.
Coordinate claim activities with legal counsel, including interpreting medical records, retaining experts, facilitating discovery, conducting research, and scheduling depositions.
Attend depositions involving Orlando Health physicians, residents, and team members.
Attend mediations for assigned claims and, when directed by Claims leadership, represent Orlando Health with agreed settlement authority.
Participate in trial activities, including focus groups, witness preparation, development of trial exhibits, and trial attendance.
Manage Department of Health licensure investigations involving employed physicians and team members with assigned legal counsel, assist in formulating responses, and attend licensing agency board meetings when a settlement agreement is reached.
Review legal bills and other invoices for compliance with the litigation plan and approve them for payment.
Prepare and update reports demonstrating the strategy for resolving assigned claims.
Attend and participate in internal claims team meetings, attorney meetings, claims strategy meetings, and pre-mediation meetings.
Maintain reasonably regular and punctual attendance and comply with Orlando Health policies and procedures.
Act as a resource for the Risk Manager, Prevention in early resolution of potential claims.
Assist in maintaining evidence for potential claims.
Archive retired policies, procedures, and related materials.
Facilitate external peer review as needed.
Work with other Orlando Health departments on insurance activities, including property surveys, safety programs, requests for certificates of insurance, and claims histories.
Participate in claims education for Orlando Health team members, physician groups, and residency programs when requested.