Claims Representative

NCMIC; Clive (IA); On-site; USD 55,000 - 85,000; Full time

Job summary

NCMIC is seeking an experienced claims professional to investigate, evaluate, negotiate, and resolve professional liability claims for insured health care providers and facilities. You will manage claims from notice through disposition, ensuring timely, fair, and cost-effective outcomes while complying with laws and company policies.

Responsibilities include handling claims intake, negotiations, letters, and settlements; attending mediations and court appearances as required; and coordinating

Qualifications

• College degree required; insurance certifications preferred.
• Valid adjuster licensure or ability to obtain within 90 days.
• 3–5 years claims handling experience, professional liability preferred.
• Strong reading of policy language and risk assessment skills.

Responsibilities

• Answer claims phone queues and document calls in notes.
• Handle professional liability and admin claims; coordinate counsel and experts.
• Draft reservation of rights and coverage letters citing policy language.
• Process settlements, pay defense/experts, and NPDB reporting.
• Attend court appearances or mediations virtually or in person.
• Perform other duties as assigned.

Skills

Time management

Negotiation

Verbal and written communication

Reading comprehension

Attention to detail

Policy interpretation

Education

College degree

Insurance certifications (AIC, SCLA, CPCU)

Adjuster licensure (or ability to obtain in 90 days)

Job description

Description

Job Details

Position Purpose:

Responsible for the investigation, evaluation, negotiation, and resolution of professional liability claims involving insured health care providers and facilities. This role manages claims from initial notice of claim through final disposition, ensuring timely, fair, and cost-effective outcomes while complying with applicable laws, regulations, and company policies.

Essential Functions

• Answering phone calls in the claims phone queues, including risk management questions and claim reporting intake, and documenting all phone calls in detailed claim or policy notes.
• Handling professional liability claims and administrative claims such as licensing board proceedings and insurance audits, including claim intake, coverage verification, claim opening, assigning counsel, retaining expert consultants, review of medical records, investigating, evaluating, providing directives and communicating with defense counsel, and negotiating settlements within provided settlement authority.
• Drafting claim letters, including detailed reservation of rights letters, coverage denial letters citing specific policy language, basic claim opening and closing letters.
• Completing financial transactions, including settlement payments with NPDB reporting, paying defense and expert bills both manually and via Datalytics, completing check voids.
• Attending court-ordered appearances and mediations, either virtually or in-person as required.
• Other duties as assigned.

Requirements

• Education: College degree with insurance certifications such as AIC, SCLA, and CPCU preferred. Valid applicable adjuster licensure or ability to become licensed within 90 days.
• Experience: 3-5 years claims-handling experience, with emphasis on professional liability claims preferred.
• Skills: Excellent time management and ability to prioritize pending work based on urgency. Excellent negotiating skills, verbal and written communication skills, listening and reading comprehension, attention to detail. Ability to read and interpret insurance policy language, apply it to various claim scenarios, and effectively communicate coverage decisions. Knowledge of medical and legal terminologies and concepts.
• Mental Demands: Ability to focus on tasks for extended periods of time. Flexible and able to work with a variety of tasks and colleagues. Ability to plan, organize, be detail and deadline oriented, and maintain high accuracy. Able to maintain professional communications when discussing sensitive topics, questions, or claims situations. Able to interpret data and problem solve to make effective and efficient decisions independently or collaboratively.
• Physical Demands: Continuous sitting, some standing, walking, bending and reaching. Frequent use of fingers and hands to manipulate computer, telephone, and other office equipment. Ability to travel by car or plane if necessary.