Senior Claims Consultant

 

Senior Claims Consultant

 

What you will be doing:

This position will be responsible for managing all aspects of catastrophic medical professional liability claims for designated clients/insureds. Management of claims includes but is not limited to: identification of prospective losses, coverage assessments and formulation of coverage opinions, regular strategy meetings with insured’s claims counterparts, identification and deployment of national resources, reporting to Chief Legal Officer on case status, creating reserve reports and making reserve recommendations, assessing and tracking aggregate erosion. This position will also be responsible for tracking developments in the industry and gathering and sharing relevant information within Premier Insurance Management Services and with American Excess Insurance clients. In person meetings will be required with clients and for governance purposes.

Key Responsibilities

Responsibility #1– 75%

• Establish and regularly maintain claims files as primary owner of individual claims for multiple insureds

• Review and manage claims of varying severity to isolate high severity matters and develop supervisory plan for loss cost containment

• Develop thorough understanding of critical issues in order to provide recommendations to internal and external stakeholders regarding resolution / outcome

• Demonstrate proactive intellectual curiosity regarding claim trajectory to curate solution-oriented strategies for defense

• Establish timely and appropriate loss and expense reserve recommendations based on careful analysis of liability, damages, and aggravating factors

• Review and assess insured’s individual policies of insurance and provide coverage assessment to CLO

• Partner with coverage counsel when necessary to prepare coverage opinions

• Review and assess client and attorney work product to ensure adherence to AEIX Best Practices Playbook

• Retain and partner with AEIX defense counsel in accordance with company’s litigation management guidelines

• Coordinate the case-specific work of defense counsel, outside vendors, investigators, experts, structured settlement brokers and review billing submissions for accuracy

• Obtain directional review from CLO and Senior Director, Claims when needed

• Maintain caseload of high complexity and high severity claims; document claim files accurately and in timely fashion

• Monitor trial calendars for all assigned clients and prepare timely trial reports

• Manage workflow, including proofreading, to provide customers with superior service and work-product

• Develop and implement specific action plans to present to clients for purpose of correcting deficiencies, “lessons learned”

• In conjunction with Claims Support Specialist, collect, review, edit, and present to CLO all necessary documentation for payment of claims

• Understand and assess aggregate erosion and when necessary, conduct aggregate audits, viewing all files in a policy year for potential to breach layer

• When necessary, conduct claim audits on departed owners to assess risk in run-off

• Manage the negotiation of claims settlement packages including setting reserves; authorizing payment

Responsibility #2 – 25%

• Travel to client for strategy meetings, settlement conferences, mediations and trials as necessary

• Participate in, and travel to, insureds offices for claims overview meetings, AEIX governance meetings, and industry conferences as directed by CLO

• Conduct approximately 5-10 annual audits virtually or on site at insured hospitals. Audits include claim reviews, which are provided to hospital leadership when complete. May conduct severity audit, meeting with local counsel and insured to discuss case strategies, management, and values.   

​Required Qualifications

Work Experience:

Years of Applicable Experience -