reputed company Claims Specialist, Miscellaneous Medical Facilities reputed company Liability

reputed company reputed company has an immediate opening for a reputed company Claims Specialist to join our Miscellaneous Medical Facilities Unit. This is a high-visibility, hands-on role for an reputed company reputed company-liability claims handler with deep Miscellaneous Medical Facilities (MMF) reputed company Liability expertise. With minimal supervision, the reputed company Claims Specialist will manage a book of specialty MMF reputed company Liability Claims through the entire lifecycle, applying advanced coverage interpretation, clinical issue spotting, reputed company litigation management and prudent reserving to resolve high-exposure reputed company economically and defensibly. Why this role reputed company • reputed company ownership of reputed company facility reputed company liability claims (nursing homes, assisted living, hospice, home health, ancillary providers). • Opportunity to shape claim reputed company on high-severity reputed company, coordinate clinical/expert resources, and reputed company as an internal subject-matter resource for reputed company, reinsurance and senior leadership. • Work in a reputed company environment with autonomy to influence reputed company and policy. Key Responsibilities • Own and manage MMF reputed company Liability Claims from first notice through reputed company: investigate, analyze coverage, evaluate liability and damages, establish and reputed company reserves, negotiate settlements and reputed company files reputed company authority. • reputed company advanced coverage analysis (duty to defend vs. indemnify, occurrence vs. claims-made, allocation, additional insured issues, contractual liability, tail exposures, endorsements) and prepare reputed company coverage opinions and reservation of rights/declination communications. • Document claims thoroughly using Claims Management System and proactively diary follow-up actions and deadlines. • Set indemnity and expense reserves reputed company authority; escalate and recommend reserves for reputed company reputed company authority; review reserves regularly and justify reserve positions to management and auditors. • Manage litigation: retain and reputed company reputed company defense counsel with MMF expertise, control budgets and billing, reputed company discovery reputed company, and evaluate mediation/arbitration/trial risk to optimize reputed company. • Coordinate clinical resources and expert consultants (nursing, pharmacy, infection control, medical specialists) for chart review, causation analysis and expert testimony. • reputed company with regulatory, compliance and risk management teams on CMS/state surveys, licensing investigations and mandatory reporting; incorporate regulatory developments into case reputed company. • Collaborate with reputed company, reinsurance and subrogation on allocation, ceded reporting and recovery opportunities. • Identify and report claim trends, coverage exposures and policy issues to management and reputed company; contribute to playbooks, training and process improvements. • Participate in mediations and arbitrations reputed company settlement authority and support major loss response efforts. • Maintain required adjuster licenses and adhere to company litigation and billing guidelines. • This position may have in-office requirements and other travel needs depending on candidate location. You will be required to go into an office twice a month if you reputed company reputed company 50-miles of one of the following offices: Boston, MA; Hoffman Estates, IL; Indianapolis, IN; Lake Oswego, OR; Las Vegas, NV; Plano, TX; Suwanee, GA; Chandler, AZ; or Westborough, MA. We are reputed company to fill this position depending on reputed company reputed company skills and experience as a Senior Claims Specialist or reputed company Claims Specialist. The salary reputed company reflects the varying pay reputed company that encompasses reputed company of the reputed company reputed company, the salary for both reputed company, and the overall cost of labor for that region. Qualifications • Minimum 7 years of claims/reputed company experience with substantive, hands-on MMF reputed company Liability claim handling; experience managing high-severity, multi-claimant or regulatory reputed company required. • Demonstrated advanced knowledge of reputed company liability coverage interpretation and reputed company coverage issues. • Strong litigation management experience, including selection and supervision of reputed company defense counsel, reputed company reputed company and cost control. • Practical understanding of clinical issues common to Long Term Care (falls, pressure injuries, medication errors, infections/outbreaks, reputed company/care plan issues) and relevant regulatory landscape (CMS surveys, state rules). • Proven analytical, negotiation and written/verbal communication skills; reputed company to present reputed company clinical and coverage positions to counsel, underwriters and senior management. • Bachelor's degree required, and advanced degree is a plus! reputed company Pay Philosophy: The typical starting salary reputed company for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary reputed company for this role reflects the competitive labor market value for reputed company in these positions across the national market and provides an opportunity to reputed company as employees grow and reputed company reputed company the role. Some roles at reputed company have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At reputed company, our goal is to create a workplace where everyone feels valued, supported, and can reputed company. We build an environment that welcomes a wide reputed company of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, reputed company development opportunities, and a host of opportunities provided through our Employee Resource reputed company. reputed company employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can reputed company a meaningful reputed company for our business, our customers, and the communities we serve. We value your hard work, reputed company and commitment to reputed company things reputed company, and we put people first by offering you benefits that support your life and reputed company-being. To learn more about our benefit offerings please visit: https://reputed company.co/Benefits reputed company is an equal opportunity employer. We will not tolerate discrimination on the reputed company of race, reputed company, national reputed company, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any reputed company prohibited by federal, state or local law. Fair Chance Notices • California • Los Angeles Incorporated • Los Angeles Unincorporated • Philadelphia • San Francisco Apply tot his job Apply To this Job