Medical Malpractice Claims Administrator
Job Description
Medical Malpractice Claims Administrator
Property and Casualty Insurance Industry
Claims Administrator works under direct supervision of the Vice President of Risk Management, receiving and processing incoming claims, assisting in the claims management process and managing communication with regard to claims. Responsible for managing data extraction regarding potential claims from fax, e-mail or other communication sources. Examine, evaluate claims for denial, subrogation and possible fraud and report to VPRM. Enter claims in system; review claims, update/correct information in system. Assign and diary for VP of Risk Management the initial action plan for case. Assist in maintaining all medical documentation and records regarding workers compensation cases. Make contacts (4 point contact) with client, adjuster, employee and provider. Report claims to carrier and VP of Risk Management. Manage correspondence; answer e-mails and phone calls, note files. Participate in claims reviews with client representatives when needed. Ensure all claimants complete all necessary paperwork regarding claim case, i.e. incident report, medical release form, LD forms and special programs are being carried out initially. Establish and maintain effective liaising between claimant, adjuster, provider and client. Provide VP of Risk Management with weekly/monthly overview and assurances that all services have been effective.
Minimum 2 years insurance industry experience preferably in a multi-state, multi-facility environment. Associate’s degree preferred or equivalent years of experience. Strong computer literacy. Knowledge of insurance related laws and medical and legal terminology. Excellent written/oral communication skills and ability to interact with personnel at various levels. Excellent organizational skills. Strong sense of accuracy and attention to detail. Ability to exercise tact and discretion in handling of confidential material. Ability to manage multiple projects, tasks and priorities to achieve desired goals. Ability to work effectively with employees at all levels within the organization.