Liability Claims Adjuster III

Intercare Insurance • New York, NY

86d

About The Position

This is a dynamic claims and account management position. In accordance with applicable statutes and in keeping with company rules, regulations, client guidelines and established performance objectives, this role is responsible for effectively managing to conclusion an assigned inventory of medical professional and general liability claim files that may include cases of extreme complexity or with unique or unusual issues. This position is multifaceted and includes the following primary areas of focus: Culture – Every member of the Intercare team is responsible for nurturing and promoting a healthy culture. Our culture is the most important element of our success. Intercare’s culture is defined by our Core Values: INTEGRITY: Reinforces our commitment to transparency, COLLABORATION: Strengthens our passion for customer service, ACCOUNTABILITY: Supports our actions, RESPECT: Inspires us to do the right thing, EXCELLENCE: Drives our outcomes. Claims Management – This teammate will be directly responsible for claim and account management. Expectations regarding claim and account management are best described by our mission: To be the leading third-party administrator offering professional and technological resources through proactive and aggressive claims, risk and managed care solutions in support of our clients’ objectives. Innovative processes and state-of-the-art technology support our people. Exceptional individuals provide the human element needed to deliver excellent service and drive excellent outcomes. Quality – The leader works closely with every member of the Intercare team to carry out our vision to promote growth: To be recognized as the most trusted and innovative partner in providing Claims and Managed Care solutions that are tailored to the specific needs of our clients.

Requirements

• JD and/or RN preferred.
• Bachelor’s degree from a four-year college or university.
• At least seven years of related experience and/or training; or an equivalent combination of education and experience.
• Requires a high degree of claims handling expertise, including at least five years managing medical professional liability cases, many with complex litigation or high potential value.
• Ability to read, analyze and interpret insurance policies, statutes, legal opinions, business periodicals, professional journals, technical procedures and governmental regulations.
• Ability to write complex coverage letters, reports, business correspondence, procedure manuals and correspondence to clients, colleagues and industry peers.
• Ability to effectively present information verbally and in writing and respond to questions from groups of managers, clients, customers and the general public.
• Fluent spoken and written English is required.
• Proficiency in Word, Excel, Outlook, PowerPoint, RMIS software, RingCentral, Zoom, TEAMS, WebEx, GoToMeeting and other tele-video conferencing software and apps.
• Appropriate jurisdictional adjuster license required.

Responsibilities

• Maintain a culture of positivity, respect, supportiveness, collaboration, patience, accountability and excellence.
• Assist with team building ideas and events.
• Lead by example and through service.
• Develop and maintain strong and collaborative client relationships.
• Establish prompt contact on all new losses within 24 hours of receipt of the claim, including the insured, claimant, or claimant representative, to document relevant facts surrounding the incident and obtain information relevant to analysis of liability and damages.
• Thoroughly and accurately evaluate coverage on a timely basis, document coverage analysis, identify coverage issues and draft appropriate coverage letters.
• Thoroughly and accurately investigate all claims and document ongoing case facts and relevant information necessary for establishing liability and damages.
• Perform and document ongoing analysis and evaluation and what is being done to move the case toward closure.
• Direct, manage and control the litigation process for nationwide programs.
• Assure that all assigned claims are maintained on an active 30–45-day diary and have an up-to-date plan of action outlining activities and actions anticipated for ultimately resolving the claim.
• Obtain consultant and/or expert reviews for early evaluation.
• Aggressively pursue contribution on multiple defendant cases or where provided by employment or independent contractor agreements and apportionment when there is shared liability.
• Assure that the claim file is handled in accordance with applicable statutes, in-force service contracts and company guidelines.
• Establish, monitor and adjust claim reserves in strict accordance with assigned authority levels and client claim-handling instructions.
• Exhibit and maintain a courteous and helpful attitude and project a professional image on behalf of the company and client.
• Respond to telephone messages and inquiries within 24 hours of receipt and to written inquiries within one week of receipt.
• Travel for mediations, trials, client meetings and/or industry-related conferences.
• Requires a working knowledge of medical terminology and various jurisdictional issues.
• Handle other duties and tasks as deemed appropriate by the Supervisor or Manager.

Benefits

• Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

What This Job Offers

• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 251-500 employees