Job Summary:
Responsible for day-to-day claims and litigation management, and for recommending course of action to management and OMIC Board Members on individual cases.
Location Requirements:
The ideal candidate will be based in the Midwest region of the US, but candidates who live in other locations will also be considered.
Responsibilities:
Ongoing claims investigation and evaluation of pre-litigation cases in assigned territory.
o Direct contact with insureds, claimants, plaintiff attorneys, and in-house ophthalmology experts.
o Review and analysis of medical records and documents.
o Obtaining consultants and expert reviews.
o Examination of Incident Reports for early warning.
o Developing an action plan for bringing the claim to resolution.
Continuous litigation management on cases in litigation in assigned territory.
o Selection of effective defense counsel
o Development of a positive working relationship with all counsel and experts.
o Monitoring, controlling and approving defense costs,
o Development and overseeing a claim resolution strategy
o Supervising and approving the selection of defense experts.
o Monitoring and reporting on trials, arbitrations and high loss settlements.
o Coordination of calendar and diary system for optimum claims management.
o Contact with and control of interactions with Plaintiff’s Counsel
Responsible for ultimate claims disposition
o Direct negotiation with claimant and or plaintiff’s attorney leading to settlement or denial. Includes attendance and participation in mediations and settlement conferences.
o Obtaining settlement consent from insureds
o Obtaining settlement/trial authority, when required, from VP, Claims, Claims Committee and/or Claims Committee Chairman.
Personal development through education, participation in professional associations, and assessment of performance, leading to strategies for refining strengths and eliminating weaknesses.
Risk management support activities, including writing articles, public relations and information dissemination.
Maintenance of accurate records.
o Timely and accurate computer claim coding
o Documentation of claim files
o Maintains case summaries in claims data processing system
o Queries claims database to monitor completeness and accuracy of claims data.
Establish indemnity reserves and all expense reserves on cases in assigned territories.
o Initial evaluation of negligence and damages.
o Continuous monitoring and update of changing facts indicating reserve adjustments.
o Anticipate and evaluate defense counsel’s costs.
Reports directly to Claims Committee on all cases with indemnity reserves of $500,000 or more, including attendance and participation at OMIC Board and Committee Meetings.
Manages/supervises investigation activities of contract claims adjusters on assigned cases.
Conforms to and operates within the internal policies, procedures and systems relative to the claims department operations.
Required Education/Experience:
· Bachelor’s degree required. Claims, medical or legal background strongly preferred.
· Minimum 5 years claims handling experience, preferably in professional liability.
· Proven negotiation skills; experience in dealing with physicians and attorneys.
· Superb oral and written communications skills. Good analytical abilities, including familiarity with various venues and state statutes.
· Basic medical knowledge in the specialized field of ophthalmology.
· Basic computer knowledge, and proven skills with a claims electronic file system such as Image Right and OASIS
Physical Requirements:
The physical demands described herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.
While performing the duties of this job, the employee is regularly required to speak, hear, and must be able to use hands and fingers to manipulate equipment including computers and telephones. Specific vision abilities required by this job include close vision. The employee frequently is required to sit or stand for long periods of time and reach with hands and arms. The employee may occasionally lift and/or move up to 10 pounds.
Travel Requirements:
Must be able to travel to domestic locations multiple times a year. Must be able to attend weekend conferences in a variety of cities.
This job description is not intended to describe, in detail, the multitude of tasks that may be assigned but rather to give the employee a general sense of the responsibilities and expectations of his/her position. As the nature of business demands change so, too, may the essential functions of this position.
Salary: $101,619 - $124,483, plus bonus, profit share, and benefits
To apply, please send cover letter and resume to careers@omic.com