Professional Liability Claims Manager

AdventHealth; Altamonte Springs (FL); Remote; USD 75,000 - 95,000; Full time

Job summary

AdventHealth seeks a Claims Manager to oversee potential compensable claims and manage professional liability claims with expertise in evaluation and negotiation. The role demands a suitable educational background and relevant experience to handle complex cases effectively. Join a community-focused organization dedicated to the wholeness and well-being of individuals while thriving professionally.

Benefits

Benefits from Day One

Paid Time Off from Day One

Career Development

Whole Person Wellbeing Resources

Mental Health Resources and Support

Qualifications

• 5+ years of experience handling professional and general liability claims.
• Florida 6-20 all-lines adjuster license required.
• Bachelor’s degree preferred in relevant fields.

Responsibilities

• Manage complex professional and general liability claims across multiple jurisdictions.
• Evaluate claims, negotiate settlements, and direct litigation activities.
• Coordinate investigations and document findings thoroughly.

Skills

Claims Management

Negotiation

Investigation

Legal Liability Assessment

Education

Bachelor’s degree in Nursing, Business Administration, or Psychology

Tools

RiskMaster

Job description

All the benefits and perks you need for you and your family:

• Benefits from Day One
• Paid Time Off from Day One
• Career Development
• Whole Person Wellbeing Resources
• Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Full Time

Shift : Monday – Friday

Location: Remote

The role you’ll contribute:

This position is responsible for the management of assigned potential compensable claims, asserted claims and suits. Management encompasses investigation, evaluation, negotiation and settlement activities, attorney supervision and trial support. This position is responsible for handling professional and general liability claims and knowing the relevant case law in multiple jurisdictions as assigned.

• The value you’ll bring to the team:
• Manages complex professional and general liability claims in multiple jurisdictions which could require travel to healthcare facilities, depositions, mediations and trials.
• Manages the day-to-day claim development by directing and coordinating investigations, determining legal liability and assessing damages.
• Must be able to create and maintain an effective diary management system to ensure all claims are given the appropriate attention.
• Sets, maintains and justifies appropriate reserves taking in consideration the projection of claim payments and verdicts in the jurisdiction.
• Navigates the claims process by determining liability, causation and damages and negotiating resolution or positioning matters for trial.
• Controls and directs counsel’s litigation activities which includes case strategy, settlement negotiations and/or trial preparation.
• Have knowledge of coverage limits and carriers for applicable line of business
• Timely reports cases to carriers whether Trust, Excess or Re-insurer as documented in RiskMaster.
• Directs and coordinates investigation to determine legal liability at facility level and documents findings.
• Effectively involves local risk managers in the investigation process and ensures CEO (or designee) is informed throughout the development of the case.
• Documents in the claim file investigation information, coverage determination, liability exposure, case value and management strategy relating to decisions of defense and resolution.
• Reviews the file periodically and assures that all documents, data entry, reports and CAR are included in the electronic file to support the actions and claims management decisions.
• Sets, maintains and justifies appropriate reserves and periodically analyzes reserves and documents rationale for reserve changes throughout the life of the claim.
• Personally evaluates the monetary value of a claim, facility impact and other party contribution in order to assign appropriate reserves and determine settlement value.
• Defense counsel is assigned in consultation with the Department Director.
• Litigation plan is discussed with defense attorneys, facility administration and Risk Managers and a strategy developed.
• Controls and directs counsel’s litigation activities.
• Follows protocols for the request of authority, with proper documentation and allowing time to process it.
• Avoids assignment of multiple attorneys to a claim and obtain authority from superiors in circumstances requiring appointment of more than one attorney to a claim.
• Controls and directs defense counsel settlement negotiations, taking in consideration the best interest of those involved.

The expertise and experience you’ll need to succeed:

EDUCATION AND EXPERIENCE REQUIRED:

• Bachelor’s degree in Nursing, Business Administration, insurance claims management, sociology, psychology, or human behavior studies background beneficial AND 5+ years of experience handling professional and general liability claims
• OR 15+ years of claims handling experience in the industry

LICENSURE, REGISTRATION, OR CERTIFICATION REQUIRED:

• Florida 6-20 all-lines adjuster license