Medical Malpractice Claims Adjuster III

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Intercare Holdings Insurance Services

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201 - 500 employees

Insurance • Risk Management

Intercare Holdings Insurance Services is a privately held company that specializes in workers' compensation and liability claims administration, managed care services, and risk management solutions. Known for their client care and responsive service, Intercare integrates advanced technology and has an in-house Special Investigations Unit (SIU) to handle claims efficiently and reduce fraudulent activities. Their unique approach combines the depth and capacity of a large organization with the flexibility of a smaller firm, ensuring customized risk management and cost control solutions for clients. With a strong emphasis on customer satisfaction, Intercare is a trusted partner in reducing risk and maintaining fiscal stability for their clients.

📋 Description

• Maintain 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 to include the insured, claimant, or claimant representative to document relevant facts surrounding the incident itself as well to 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 document 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 to 45 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 as well as 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

🎯 Requirements

• JD and/or RN preferred • Bachelor's degree from four-year college or university • At least seven years related experience and/or training, or equivalent combination of education and experience • Requires a high degree of claims handling expertise to include a minimum of at least five years' experience managing medical professional liability cases, many with complex litigation or high potential value • Ability to read, analyze, and interpret insurance policies, statutes, legal opinions, general 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, both verbally and written, and respond to questions from groups of managers, clients, customers, and the general public • Fluent spoken and written English is required.

🏖️ Benefits

• Comprehensive medical, dental, and vision benefits • Company contributions to HSA and FSA plans • Employer paid life and disability insurance • 401(k) with company match • Paid time off (PTO) and company paid holidays • Learning and development opportunities that support real career advancement • Employee assistance resources and a supportive culture that values balance and wellbeing