Job Title Director of Claims
Country USA
Job Description

Our client is one of the nation’s largest providers of professional liability insurance and other services for physicians. They seek a Director of Claims for their PA location. They offer a family-friendly work environment and a competitive compensation/benefits package, including 401(k), pension, annual bonus, group health, dental and vision, and much more.

Director of Claims

Summary of Position: This individual will be responsible for the supervision of the Claims staff and management of medical malpractice claims in a PA location. The desired candidate will provide regular reports to the VP of Claims and senior management regarding reserves, claims, and trends. Additionally, the selected candidate will partner with underwriting and risk management to develop and maintain business.

Responsibilities:

  • Audit files and provide guidance to staff consistent with best practices and claims handling guidelines, and litigation/billing guidelines.
  • Review and edit reports to conform to internal reporting standards.
  • Assure direct reports perform timely reserving of files.
  • Manage a modified caseload in addition to supervisory responsibilities.
  • Prepare monthly/quarterly summaries for senior management.
  • Review coverage letters for accuracy, appropriateness, and grammar.
  • Accompany underwriting and/or risk management on marketing trips.
  • Conduct claims reviews or audits with clients.
  • Investigate and evaluate claims including high severity matters.
  • Analyze coverage issues and create/issue coverage positions.
  • Manage litigation by directing or collaborating with defense counsel and insureds.
  • Negotiate claim resolutions either by participating in mediations or directly with claimant/claimant’s counsel.
  • Monitor trials as required.
  • Establish appropriate and timely reserves including preparation of reports and presentation at Large Loss Reserve meetings.
  • Present at Upcoming Trial Meetings.
  • Monitor and identify claim developments and trends to management and underwriting.
  • Select/monitor/supervise/review outside defense panel counsel.
  • Provide superior customer service by effectively interacting with insureds, brokers, defense counsel & other parties as necessary.
  • Collaborate with peers to share information and service internal and external customers.

Qualifications:

  • Bachelor’s degree required with 10 years’ experience handling medical liability insurance claims
  • 3-5 years of supervisory experience
  • Proficiency in policy review and coverage
  • Knowledge of CMS reporting requirements, NPDB reporting requirements and state medical board reporting requirements
  • Outstanding customer service skills and the ability to direct staff to provide same
  • Ability to audit files and provide guidance to staff
  • Excellent negotiation & communication skills
  • Technical writing experience (writing sample may be requested)
  • Strong computer skills including proficiency in MS Office products