Medical Malpractice Claims Adjuster (State)

State of Louisiana; Baton Rouge (LA); On-site; USD 52,000 - 75,000; Full time

Job summary

Patient's Compensation Fund in Louisiana seeks a capable claims professional to drive the vision of the section and manage independent judgment in medical malpractice claims. You will handle complex cases, maintain confidentiality, and work with a team to ensure accurate, timely processing.

The role requires negotiating with insurers and attorneys, applying policy rules, and using PRISM for claims processing.

Qualifications

• Competencies include following guidance, effective communication, policy adherence, sound judgment, decisive action, integrity, adaptability, professionalism, and customer focus.

Responsibilities

• Monitor the medical review panel process and update records.
• Correspond with primary insurers, defense attorneys, and outside adjusters to determine validity, exposure, and status of claims.
• Evaluate information to determine if the layer of primary coverage could be exceeded and refer cases over $100,000 to the supervisor.
• Maintain ongoing contact with assigned future medical claimants, their caregivers, vendors, and health care providers.
• Request medical reports and bills and verify relation to medical malpractice claims.
• Process payment requests, review reasonableness, and disallow unnecessary charges after senior examiner input.
• Obtain estimates to modify homes and vehicles for handicapped individuals.

Skills

Accepting Direction

Communicating Effectively

Following Policies and Procedures

Making Accurate Judgments

Acting Decisively

Ethics and Integrity

Adapting to Change

Professionalism

Focusing on Customers

Education

Bachelor's degree

Tools

PRISM software

Job description

Patient's Compensation Fund in Louisiana seeks a capable claims professional to drive the vision of the section and manage independent judgment in medical malpractice claims. You will handle complex cases, maintain confidentiality, and work with a team to ensure accurate, timely processing.

The role requires negotiating with insurers and attorneys, applying policy rules, and using PRISM for claims processing.