Claims Management Counsel

Northwell Health

3d

About The Position

Participates in the management of a Claims Management Program. Prioritizes and monitors claims filed, evaluates insurance coverage, ensures reporting of claims to primary and excess insurance, conducts and/or monitors claims audits; evaluates and monitors reserves; oversees defense counsel. Monitors a comprehensive, integrated system for managing non-workers’ compensation claims for the organization and its affiliates; assists in managing a caseload of assigned claims. Ensures reporting of claims to insurance carriers; conducts insurance coverage analyses. Reviews and evaluates insurance carrier coverage responses including reservation or rights and coverage denials; evaluates loss runs to ensure adequate reserving of claims at all layers of primary and excess coverage. Oversees third party claims and defense counsel in the management of all aspects of assigned claims including day-to-day management, case reserves, expenses and motion practice; maintains current claim information in the database. Ensures appropriate expert reviews; evaluates claims focusing on exposure, severity, reserves, and trial dates. Monitors cases on trial and attends trials, when necessary; identifies cases requiring early/pre-trial resolution. Collects and reviews claims data to identify trends and opportunities for loss control; collaborates with risk management to recommend loss control initiatives. Serves as a liaison between the organization, Third Party Claims Administrator and Insurance Broker in all aspects of claims management; monitors claims impacting on the health system's Insurance Captive Insurance company, Self Insurance Program and/or deductibles, Reviews insurance and related provisions of written agreements. Operates under general guidance and work assignments are varied and require interpretation and independent decisions on course of action. Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions.

Requirements

• Juris Doctor required.
• 1-3 years of relevant experience, required.

Nice To Haves

• Claims Counsel experience preferred.
• Experience working in a law firm preferred.

Responsibilities

• Monitors a comprehensive, integrated system for managing non-workers’ compensation claims for the organization and its affiliates; assists in managing a caseload of assigned claims.
• Ensures reporting of claims to insurance carriers; conducts insurance coverage analyses.
• Reviews and evaluates insurance carrier coverage responses including reservation or rights and coverage denials; evaluates loss runs to ensure adequate reserving of claims at all layers of primary and excess coverage.
• Oversees third party claims and defense counsel in the management of all aspects of assigned claims including day-to-day management, case reserves, expenses and motion practice; maintains current claim information in the database.
• Ensures appropriate expert reviews; evaluates claims focusing on exposure, severity, reserves, and trial dates.
• Monitors cases on trial and attends trials, when necessary; identifies cases requiring early/pre-trial resolution.
• Collects and reviews claims data to identify trends and opportunities for loss control; collaborates with risk management to recommend loss control initiatives.
• Serves as a liaison between the organization, Third Party Claims Administrator and Insurance Broker in all aspects of claims management; monitors claims impacting on the health system's Insurance Captive Insurance company, Self Insurance Program and/or deductibles.
• Reviews insurance and related provisions of written agreements.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level