Liability Claims Adjuster III

Job Type Full-time Description

Summary:

This is a dynamic claims and account management position. In accordance with applicable statutes and in keeping with company rules, regulations, client guidelines, and established performance objectives, this role is responsible for effectively managing to conclusion an assigned inventory of medical professional and general liability claim files. These may include cases of extreme complexity or those with unique or unusual issues.

This position is multifaceted and includes the following primary areas of focus:

Culture

Every member of the Intercare team is responsible for nurturing and promoting a healthy culture. Our culture is the most important element of our success. Intercare’s culture is defined by our Core Values:

• INTEGRITY: Reinforces our commitment to Transparency
• COLLABORATION: Strengthens our passion for Customer Service
• ACCOUNTABILITY: Supports our actions
• RESPECT: Inspires us to do the right thing 
• EXCELLENCE: Drives our outcomes 

Claims Management

This teammate will be directly responsible for claim and account management. Expectations regarding claim and account management are best described by our mission:

Mission: To be the leading third-party administrator offering professional and technological resources through proactive and aggressive claims, risk, and managed care solutions in support of our clients’ objectives. Innovative processes and state-of-the-art technology support our people. Exceptional individuals provide the human element needed to deliver excellent service and drive excellent outcomes. 

Quality

The leader works closely with every member of the Intercare team to carry out our vision to promote growth.

Vision: To be recognized as the most trusted and innovative partner in providing Claims and Managed Care solutions that are tailored to the specific needs of our clients

Essential Duties And Responsibilities:

• Maintain a 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, including the insured, claimant, or claimant representative to document relevant facts and obtain information for liability and damage analysis
• 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, document ongoing case facts, perform and document ongoing evaluations, and note progress toward claim resolution
•  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 
• Maintain all assigned claims on an active 30–45 day diary and keep an up-to-date plan of action 
• Obtain consultant and/or expert reviews for early evaluation
• Aggressively pursue contribution on multi-defendant cases or those involving employment/independent contractor agreements with shared liability 
• Ensure all claims are handled in accordance with applicable statutes, service contracts, and company guidelines
• Establish, monitor, and adjust reserves according to authority levels and client instructions
• Exhibit a courteous and helpful attitude and project a professional image for the company and clients 
• Respond to phone messages within 24 hours and to written inquiries within one week
• Travel for mediations, trials, client meetings, and/or industry conferences
• Maintain working knowledge of medical terminology and jurisdictional issues 
• Handle other duties as assigned by Supervisor or Manager

 Competency: To perform the job successfully, an individual should   demonstrate the following competencies: 

• An open mind, an eagerness to learn, a positive attitude and healthy curiosity. 
• Strong  communication skills including being open and respectful of everyone, regardless of their position or role in the world. 
• Flexibility and the ability to adapt to change quickly. This includes the ability to switch gears efficiently between various program needs, and client and colleague personalities numerous times throughout the day. 
• Problem solving, change and conflict management including being able to develop workable implementation plans and recommendations, communicating changes effectively, building commitment and overcoming resistance, and preparing and supporting those affected by change and conflict. 
• Leadership by example and service, including instilling and exhibiting confidence in yourself and others, inspiring and motivating others to perform well,  ethically and positively influencing the actions and opinions of others, inspiring respect and trust, accepting and growing from the feedback from others, providing vision and inspiration to all colleagues, providing appropriate recognition to others, displaying passion and optimism, mobilizing others to fulfill the vision, accepts responsibility and accountability. 
• Exceptional customer service including always going above and beyond for clients, searching for ways to expand our services for each client, soliciting client feedback to improve service, promptly responding to all client needs and requests  and ensuring compliance with client contracts and service instructions. Responds to requests for service and assistance. Meets commitments.
• Strong business acumen including being well spoken, displaying poise,  presenting yourself and Intercare with a measured balance of confidence  and humility, taking initiative, sparking innovation, understanding the business implications of decisions, displaying orientation to profitability, demonstrating knowledge of the market and competition, and aligning work with strategic goals.
• Discipline in all aspects of the position with a focus on accuracy, thoroughness and constant desire for improvement.
• Project management skills, including developing project plans, coordinating projects, staying/keeping on task, communicating changes and progress, and completing projects on time and budget.

Qualification Requirements:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education And/Or Experience:

• 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. 

Language Skills:

• 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.  

Math Skills:

• Ability to add, subtract, multiply,   and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and   interpret bar graphs.

Reasoning Ability:

• This position requires strong problem solving and analytical skills. It requires the ability to apply common sense understanding to carry out instructions furnished in   written, oral, or diagram form. It requires the ability to deal with problems involving several concrete   variables in standardized situations. 

Computer Skills:

•  To perform this job successfully, an individual must be proficient with Word, Excel, Outlook, PowerPoint, RMIS software, RingCentral, Zoom, TEAMS, WebEx, GoToMeeting and other tele-video conferencing software and apps.

Certificates And Licenses:

• JS and or RN licensure preferred. Appropriate jurisdictional adjuster license required.  

Physical Demands: The physical demands described here 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. 

• Regularly required to sit. 
• Frequently required to use hands to finger, handle, feel, type, collate, file, or lift. 
• Required to stand and walk. 
• Some lifting may exceed 10 pounds such as luggage, collateral company materials or claim files.
• Required to travel by vehicle, airplane, subway and train. 
• Required to spend nights at hotels for out of town travel.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.  

Salary Description $150,000.00 - $185,000.00