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 - 7 or more years

Education : Bachelors (Required)

Required Certifications / Licensing

Medical Liability Claims Handling, 10+ years

Strong written and oral skills required, writing sample required

Dedicated home office space for privacy and confidentiality while working remotely.

Preferred Qualifications

Skills :

Negotiation training; experience

Experience :

Medical Liability Claims Management

Catastrophic Excess Claims Management

Experience giving group presentations

Education : Bachelors (Required)

Additional Job Requirements :

Remain in a stationary position for prolonged periods of time

Be adaptive and change priorities quickly; meet deadlines

Attention to detail

Operate computer programs and software

Ability to communicate effectively with audiences in person and in electronic formats .

Day-to-day contact with others (co-workers and / or the public)

Making independent decisions

Ability to work in a collaborative business environment in close quarters with peers and varying interruptions

Working Conditions : Remote

Travel Requirements : Travel 21-40% within the US

Physical Demands : Light : Exerting up to 20 pounds of force frequently, and / or a negligible amount of force constantly to move objects. If the exertion of forces required is greater than that of sedentary work and if the worker remains stationary most of the time, the job is considered light work.

Premier's compensation philosophy is to ensure that compensation is reasonable, equitable, and competitive in order to attract and retain talented and highly skilled employees. Premier's internal salary range for this role is $113,000 - $188,000. Final salary is dependent upon several market factors including, but not limited to, departmental budgets, internal equity, education, unique skills / experience, and geographic location. Premier utilizes a wide-range salary structure to allow base salary flexibility within our ranges.

Employees also receive access to the following benefits :

• Health, dental, vision, life and disability insurance
• 401k retirement program
• Paid time off
• Participation in Premier's employee incentive plans
• Tuition reimbursement and professional development opportunities

Premier at a glance :

Ranked #1 on Charlotte's Healthiest Employers list for 2019, 2020, 2022, and 2023 and 21st Healthiest Employer in America (2023)

Named one of the World's Most Ethical Companies by Ethisphere Institute for the 16th year in a row

Modern Healthcare Best in Business Awards : Consultant - Healthcare Management (2024)

The only company to be recognized by KLAS twice for Overall Healthcare Management Consulting

For a listing of all of our awards, please visit the Awards and Recognition section on our company website.

Employees receive : Perks and discounts

Access to on-site and online exercise classes

Premier is looking for smart, agile individuals like you to help us transform the healthcare industry. Here you will find critical thinkers who have the freedom to make an impact. Colleagues who share your thirst to learn more and do things better. Teammates committed to improving the health of a nation. See why incredible challenges require incredible people.

Premier is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to unlawful discrimination because of their age, race, color, religion, national origin, ancestry, citizenship status, sex, sexual orientation, gender identity, gender expression, marital status, familial status, pregnancy status, genetic information, status as a victim of domestic violence, covered military or protected veteran status (e.g., status as a Vietnam Era veteran, disabled veteran, special disabled veteran, Armed Forces Serviced Medal veteran, recently separated veteran, or other protected veteran) disability, or any other applicable federal, state or local protected class, trait or status or that of persons with whom an applicant associates. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law. In addition, as a federal contractor, Premier complies with government regulations, including affirmative action responsibilities, where they apply. EEO / AA / Disabled / Protected Veteran Employer.

Premier also provides reasonable accommodations to qualified individuals with a disability or those who have a sincerely held religious belief. If you need assistance in the application process, please reply to diversity_and_accommodations@premierinc.com or contact Premier Recruiting at 704.816.5200.

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