Claims Representative

TMLT; Austin (TX); On-site; USD 90,000 - 140,000; Full time

Job summary

TMLT in Austin, TX, seeks a seasoned professional to manage and resolve medical malpractice claims against insured physicians. You will oversee investigation, evaluation, and negotiation, and supervise defense counsel on cases with light to moderate exposure.

The role emphasizes developing claim files, documenting all actions, reporting progress, and coordinating with claim staff. You will negotiate with claimants, manage defense teams, and participate in mediations and trials as needed.

Qualifications

• Bachelor's degree preferred; minimum five years in property and casualty insurance with professional liability and bodily injury claims experience.
• Adjuster's License required; Texas Casualty Adjuster's License within 90 days if not held.
• Strong data management and supervisory capability.
• Ability to present facts clearly to management, policyholders, and defense counsel.

Responsibilities

• Verify coverage and promptly investigate liability and damages on assigned claims.
• Ensure proper evaluation and reserving of assigned claims.
• Develop claim files and document all file transactions.
• Negotiate with claimants or their legal representatives and disposition within authority.
• Select and supervise defense counsel, manage discovery and defence.
• Attend mediations, trials, and CRC meetings.
• Complete reporting forms for State Medical Board and NPDB when required.
• Travel frequently for mediations and trials.
• Provide feedback to supervisor on performance.

Skills

Analytical skills

Detail oriented

Supervisory skills

Oral and written communication

Education

Bachelor's degree preferred

Adjuster's License required

Tools

Microsoft Office

Word

Excel

Internal programs

Job description

Responsible for the management and resolution of medical malpractice claims brought against insured physicians. This process includes investigation, evaluation, and negotiation, as well as supervision of defense counsel on cases with potentially light to moderate exposure and may also include Medefense claims and “depo only” and incident files.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Verifies coverage as determined by claim technician and performs the prompt investigation of liability and potential damages of assigned claims.
• Ensures proper evaluation and reserving of assigned claims.
• Develops claim files on assigned cases, documenting all transactions related to file handling.
• Reports progress and results in a timely manner and in accordance with claim department directives.
• Negotiates directly with claimants and/or their legal representatives and is responsible for prompt and proper disposition of all claims within delegated authority.
• Selects and assigns defense counsel; works closely with defense counsel to manage their use of discovery proceedings and to ensure effective defense of suits.
• Manages expenses including reasonableness of attorneys' fees.
• Seeks standard of care opinions from outside consultants. Suggests additions and/or deletions to consultant list.
• Attends and monitors trials.
• Coordinates and participates in Litigation Management Reviews for selected defense firms.
• Completes State Medical Board and National Practitioner Data Bank reporting forms (if required) upon closing a claim.
• Attends and participates in Claim Review Committee (CRC) meetings as scheduled. Prepares and poses questions to CRC members on medical aspects of selected cases.
• Develops personal and professional goals and plans to achieve them. Pursues a continuous program of self-development.
• Provides feedback to the Claim Technician Supervisor on the job performance of his/her assigned Claim Technician.
• Attends defense meetings with attorneys and policyholders when appropriate.
• Attends and participates in mediations including the direction of negotiations, if any.

REQUIRED KNOWLEDGE, SKILLS, ABILITIES, AND EXPERIENCE:

• Basic knowledge of data base utilization and MicroSoft Office, Word, Excel and internal programs.
• Knowledge and understanding of basic professional liability insurance contracts, regulations, and litigation.
• Basic knowledge of the practice of medicine and of medical terminology.
• Demonstrated claim file supervisory skills.
• Strong analytical skills. Detail minded. Highly accurate.
• Ability to present facts and recommendations effectively in oral and written form to management, policyholders, and defense counsel.
• Ability to work with frequent interruptions.
• Ability to supervise and motivate.
• To be eligible for this position, employee must maintain an acceptable driving record (as determined by TMLT in its own discretion) and must notify TMLT upon being cited for any moving violation or other violation or condition that affects the employee’s ability to legally operate a motor vehicle.

MINIMUM EDUCATION, TRAINING, AND EXPERIENCE:

Bachelor's degree preferred. Minimum of five years of progressively responsible experience in the property and casualty insurance field, including professional liability experience (physicians liability experience preferred) and bodily injury claims handling. Adjuster's License required. Incumbents meeting other selection criteria except possession of Adjuster's License will be required to obtain a Texas Casualty Adjuster's License within a period of 90 days,

OR

any combination of education, training, and experience which would provide the level of knowledge, skill and ability required.

OTHER:

A significant amount of time spent traveling (including overnight stays of one or more nights) to attend mediations and trials.