Liability Claims Adjuster III

Liability Claims Adjuster III

Remote Worker – N/A

Description

Summary:

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:

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:

Vision: 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.

Essential Duties and 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.

• Litigation management – 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.

Competency:

To perform the job successfully, an individual should demonstrate the following:

• An open mind, eagerness to learn, positive attitude and healthy curiosity.

• Strong communication skills, including being open and respectful of everyone, regardless of their position or role.

• Flexibility and the ability to adapt to change quickly, including switching efficiently between program needs and personalities multiple times throughout the day.

• Problem solving, change and conflict management, including developing workable implementation plans and recommendations, communicating changes effectively, building commitment, overcoming resistance and supporting those affected.

• Leadership by example and service, including instilling confidence in yourself and others, inspiring and motivating others to perform well ethically, positively influencing others, inspiring respect and trust, accepting and growing from feedback, providing vision and inspiration, recognizing others appropriately, displaying passion and optimism, and mobilizing others to fulfill the vision.

• Exceptional customer service, always going above and beyond, searching for ways to expand services, soliciting client feedback, promptly responding to requests and ensuring compliance with client contracts and service instructions.

• Strong business acumen, being well spoken, poised, presenting with balanced confidence and humility, taking initiative, sparking innovation, understanding business implications, displaying profitability orientation, knowing the market and aligning work with strategic goals.

• Discipline in all aspects of the position with a focus on accuracy, thoroughness and continuous improvement.

• Project management skills, including developing plans, coordinating projects, staying on task, communicating changes and completing projects on time and within budget.

Qualification Requirements:

To perform this job successfully, an individual must, at a minimum, be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:

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.

Language Skills:

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.

Math Skills:

Ability to add, subtract, multiply and divide in all units of measure using whole numbers, common fractions and decimals. Ability to compute rate, ratio and percent and to draw and interpret bar graphs.

Reasoning Ability:

Requires strong problem-solving and analytical skills. Ability to apply common-sense understanding to carry out instructions in written, oral or diagram form, and to deal with problems involving several concrete variables in standardized situations.

Computer Skills:

Proficiency in Word, Excel, Outlook, PowerPoint, RMIS software, RingCentral, Zoom, TEAMS, WebEx, GoToMeeting and other tele-video conferencing software and apps.

Certificates and Licenses:

JD and/or RN licensure preferred. Appropriate jurisdictional adjuster license required.

Physical Demands:

The physical demands described here are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

• Regularly required to sit.

• Frequently required to use hands to finger, handle, feel, type, collate, file or lift.

• Required to stand and walk.

• Some lifting may exceed 10 pounds, such as luggage, collateral materials or claim files.

• Required to travel by vehicle, airplane, subway and train.

• Required to spend nights in hotels for out-of-town travel.

Work Environment:

The work environment characteristics described here are representative of those encountered while performing essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions. The noise level in the work environment is usually moderate.