Claims Consultant

Copic Companies; Denver (CO); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Hybrid Schedule

Office in Denver

Job summary

Copic Companies seeks an experienced claims professional to investigate, evaluate, and manage assigned claims with a focus on coverage decisions and prudent reserves.

You will collaborate with insureds, plaintiff attorneys, and defense counsel, preparing reports and coordinating with relevant regulatory bodies as needed.

Qualifications

• 5-7 years experience as a claims consultant or adjuster.
• Strong communication, interpersonal and written skills.
• Ability to absorb and assess large volumes of information.
• Calm, professional demeanor and respect for others.
• Maintain strict confidentiality.
• Attention to detail and logical thinking.
• Basic computer literacy.
• Analytical, critical thinking and problem-solving abilities.

Responsibilities

• Resolve coverage questions; contact insured; obtain medical records; contact plaintiff attorney; defend insured’s interests; obtain expert reviews; communicate with insured physician; collaborate with defense counsel; negotiate to resolve claim.
• Make timely and accurate reports to the file; report to Board of Medical Examiners and NPDB as required; ensure ongoing status reports and communications; set reserves.

Skills

5-7 years claims exp

Effective communication

Information absorption

Confidentiality

Attention to detail

Analytical thinking

Problem solving

Basic computer knowledge

Medical terminology knowledge

Education

Medical terminology training

Job description

Reports to the Claims Supervisor; the incumbent is responsible for investigation, evaluation and resolution of assigned claim matters.

Claims Evaluation & Management (Including Reporting Requirements)

Percent of Time: 75%

• Resolve any coverage questions; contact and meet with the insured; obtain pertinent medical records; contact plaintiff attorney, if appropriate; retain defense attorney and work together as a team to defend the insured’s interests; evaluate the file by obtaining expert reviews; communicate with the insured physician as the claim develops; collaborate with defense counsel regarding the management of the claim; make wise use of resources, keeping in mind the fiduciary responsibility to the insured and Copic; negotiate effectively to resolve claim.
• Make timely and accurate reports to the file during its pendency, including new open claim report, investigation report, authority requests, pretrial report and closing summary; make timely reports where indicated to the Board of Medical Examiners and/or National Practitioners Data Bank; see that the file contains appropriate status reports and documents on-going communication between the adjuster, the insured and the defense counsel; set reserves in line with information known.

Meetings, Conferences, & Continuing Education

Percent of Time: 15%

• Attend bi-monthly Claims Committee meetings and be prepared to speak on any files assigned to you; attend settlement conferences, mediations, and trials representing the insured and Copic in a positive manner; attend other conferences as requested/assigned.Attend classes, seminars and presentations to increase knowledge of medicine, law and claims management as approved by management.

Special Projects

Percent of Time: 10%

Participate/lead fully in special projects as assigned by supervisor.

Required Qualifications & Skills

• 5-7 years of experience as a claims consultant or adjuster.
• Ability to communicate effectively, both interpersonally and in written form.
• Ability to absorb and assess volumes of information.
• Calm, professional manner which demonstrates a genuine respect of others and their point of view.
• Ability to maintain strict confidentiality.
• Ability to think logically and pay attention to detail.
• Basic computer knowledge required.
• Analytical, critical thinking, and problem-solving skills

Desired Qualifications & Skills

• Insurance claims adjusting experience.
• Risk management knowledge.
• Knowledge of medical terminology or other college level medical training.

Working Conditions

• Typical Office Environment
• Hybrid Schedule. Office located in Denver, Colorado
• 10% travel
• Schedule: Full-Time, 40 hours per week, long or unusual hours as needed, sometimes on short notice. Business Hours: 8am-5pm MST