Professional Liability Claims Specialist

VCU Health•Richmond, VA

About The Position

The Professional Liability Claims Specialist supports VCU Health’s professional liability program through coordinated claims investigation, litigation support, regulatory compliance, and administrative oversight. This role serves as a key liaison among covered providers, legal counsel, internal departments, and external agencies to ensure accurate, timely, and compliant handling of medical malpractice claims. The Specialist integrates investigative, documentation, financial, and reporting activities to support risk mitigation and informed decision-making related to claim resolution.

Requirements

High School Diploma or equivalent
Virginia Notary Public Commission License (must obtain within 60 days of hire)
Minimum of three (3) years of experience in any of the following environments: Insurance claims, Medical billing or coding, Medical records management, Healthcare administration, Legal office or administrative support
Ability to obtain, organize, analyze, and maintain medical records and billing documents with high attention to detail.
Strong organizational and time‑management skills with the ability to manage multiple priorities in a fast‑paced environment.
Clear and professional written and verbal communication skills.
Ability to interact with physicians, attorneys, patients/families, and internal departments with professionalism and discretion.
Strong reasoning, analytical, and problem‑solving abilities.
Demonstrated proficiency using personal computers and software applications such as Microsoft Office, email platforms, and document management systems.

Nice To Haves

Associate’s degree in Business, Legal Studies, Health Information Management, or a closely related field.
Certified Paralegal (CP) credential from the National Association of Legal Assistants (NALA).
Experience working in a legal setting, particularly within personal injury, medical malpractice (plaintiff or defense), or insurance defense.
Previous experience within a healthcare system or clinical operational environment.
Prior exposure to claims databases or electronic case management platforms (e.g., Origami or similar systems).

Responsibilities

Claims Investigation & Litigation Support Obtain, organize, and maintain comprehensive medical records, medical bills, imaging studies, and related documentation in accordance with federal/state regulations and VCUHS policies.
Serve as a primary point of contact for covered providers, attorneys, claimants, and internal stakeholders to gather information needed to assess and defend claims.
Partner with outside defense counsel to support discovery responses and case preparation.
Collaborate with the Professional Liability Nurse Investigator, Health Information Management, Revenue Cycle, and clinical departments.
Claims Monitoring, Reporting & File Management Monitor local courts for filings involving covered providers and retrieve pleadings and court documents.
Maintain accurate electronic claim files in claims management system (Origami) and selected hard-copy materials.
Process CMS monthly queries and quarterly reporting related to professional liability claims.
Regulatory, Committee & Administrative Coordination Coordinate Self-Insurance Committee and Claims Committee meetings and documentation.
Manage Department of Health Professions investigations and subpoena documentation.
Maintain coverage rosters and generate certificates of coverage, verification letters, and claims histories.
Financial Processing & Claims Payments Process legal, expert, vendor, and claim-related invoices.
Ensure accurate and timely recording of all financial transactions in claims management system.
Post settlement payments related to physician or hospital indemnity.
Customer Service & Professional Communication Provide timely, professional communication with internal and external stakeholders.
Notarize documents as required for litigation and regulatory support.