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Medical Malpractice Claims Specialist

2 months ago

Dubai, Dubai, United Arab Emirates Dice Full time
Job Summary

We are seeking a highly skilled Medical Malpractice Claims Specialist to join our team at Dice. As a key member of our claims management team, you will be responsible for analyzing and processing complex medical malpractice claims, negotiating claim settlements, and ensuring timely and appropriate reserves are assigned to claims.

Key Responsibilities
  • Claims Analysis and Management: Analyze and process complex medical malpractice claims, investigating and gathering information to determine the exposure on the claim, and managing claims through well-developed action plans to an appropriate and timely resolution.
  • Investigation and Reporting: Conduct or assign full investigation and provide a report of investigation pertaining to new events, claims, and legal actions.
  • Negotiation and Settlement: Negotiate claim settlement up to designated authority level.
  • Reserve Management: Calculate and assign timely and appropriate reserves to claims, and monitor reserve adequacy throughout the claim life.
  • Settlement Strategies: Recommend settlement strategies and bring structured settlement proposals as necessary to maximize settlement.
  • Coverage Analysis: Perform coverage analysis and opinion as part of the claim process, including all necessary correspondence.
  • Legal Defense Coordination: Coordinate legal defense by assigning attorneys, coordinating support for the investigation, and reviewing attorney invoices, and monitor counsel for compliance with client guidelines.
  • Cost Containment: Use appropriate cost containment techniques, including strategic vendor partnerships, to reduce overall claim costs for our clients.
  • Fraud and Recovery: Identify and investigate possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
  • Representation: Represent the company in depositions, mediations, and trial monitoring as needed.
  • Client Communication: Communicate claim activity and processing with the client, and maintain professional client relationships.
  • Documentation and Coding: Ensure claim files are properly documented and claims coding is correct.
  • Case Referral: Refer cases as appropriate to supervisor and management.
  • Work Delegation: Delegate work and mentor others.
Requirements
  • Education and Licensing: A bachelor's degree from an accredited college or university is required. Professional certification as applicable to the line of business is preferred.
  • Experience: Six (6) years of medical malpractice claims management experience or equivalent combination of education and experience is preferred.
  • Skills and Knowledge: In-depth knowledge of appropriate medical malpractice insurance principles and laws, recoveries offsets and deductions, claim and disability duration, cost containment principles, including medical management practices and Social Security application procedures as applicable to the line of business.