An exciting opportunity exists to join the ProAssurance family of companies!
We are a specialty writer of professional liability, products liability and workers' compensation insurance. With approximately 1,000 team members operating in all 50 states, we are well-positioned to offer career opportunities to individuals interested in professional growth.
This position supports our healthcare professional liability line of business and is fully-remote, based in Florida. Candidates can be based in Georgia or Alabama provided they have experience handling Florida healthcare professional liability claims.
Candidates must have experience handling healthcare professional liability claims in Florida.
The Lead Claims Specialist is the senior most professional position (non-management) on the Claims team. The role provides direction and guidance throughout the life of the complex claims, both litigated and non-litigated and mentors less experienced claims professionals. The Lead Claims Specialist directs the management of complex claims including claims investigation, coverage analysis, monitoring of defense counsel activities, control of legal expenses, reserving, and providing technical expertise throughout the life of the claim file. The claims handling involve a high degree of technical evaluation and often include complex issues, including determining coverage and assessing potential exposure in a timely and accurate manner. The Lead Claims Specialist shall aggressively analyze, assess and resolve cases from a coverage determination through ultimate resolution (including through litigation or negotiation).
Essential Duties and Responsibilities:
30% Investigates and evaluates liability, causation and damages in direct patient and litigated claims.
Ensures proper file documentation of assigned files, by complying with company and state requirements including authority levels. Establishes and continually evaluates case reserves. Accountable for the full handling and control of all claim matters assigned from inception to resolution including: timely communication; investigation; and reserve adequacy; diary maintenance; management of defense and coverage counsel; reinsurance reporting; and claim disposition.
25% Responsible for preparing reports for management, by collecting, analyzing, and summarizing claim information. Keeps apprised of changes in the law and court procedures affecting claims in jurisdictions supervised. Consistent prompt evaluation of potential exposure to all claims assigned as well as an ability to adapt to changing circumstances as claims develop. An ability to segregate potentially significant claims possessing considerable exposure from straightforward claims. Ability to consider and formulate a possible resolution strategy at the earliest possible opportunity, including setting appropriate and timely reserves and communicating with defense counsel, insureds or others to successfully achieve such strategy. Claim presentations, both written and oral, will be required on a regular and timely basis to bring management up to speed, obtain authority and/or formulate appropriate action plans on claims that present the risk for considerable exposure.
25% Collaborates with defense counsel with regard to defense tactics and strategies, per department guidelines. Maintains communication with Director and Counsel. Participates in selection of expert witnesses. Superior customer service to all co-employees, agents, policyholders and others encountered during the claims handling process is expected. Further, when needed, the Lead Claims Specialist is expected to market claim services, update underwriting department personnel on claims trends, and coordinate and participate in presentations to customers or potential customers.
15% Attends trials, settlement conferences, mediations, and insured meetings. Participates in settlement negotiations.
Secondary Duties and Responsibilities:
5% Review and approval of reasonable legal expenses and fees associated with the claim file, and negotiation of adjustment of charges when appropriate.