Claims - AVP - Managed Care

Specialty insurance company is seeking an Assistant Vice President Claims.  The primary responsibilities of this position are to investigate, evaluate and resolve managed care, medical management liability and life science claims.  The position requires handling claims across varied medical specialties that present the greatest severity and complexity in the department. 

Responsibilities include:

• Identifying and analyzing coverage issues. 
• Negotiate claim settlement within authority level.
• Review files for timely and appropriate reserves; monitor reserve adequacy throughout the life of a claim file
• Selecting defense counsel
• Litigation management including ongoing communication with defense counsel, monitoring of legal status reporting, reviewing invoices and ensuring compliance with litigation guidelines
• Attending mediations, court conferences and trials
• Regular communication with the insured from initial contact to claim resolution
• Formulating and executing claim resolution plans
• Direct handling of settlement negotiations with plaintiff’s counsel
• Promptly paying all claim expenses and indemnity obligations and reporting claim outcomes to state and federal regulatory agencies
• Presenting claims at internal claim roundtables
• Preparing claim status reports to reinsurers
• Regularly review quarterly loss runs for increase in reserves or severity matters, alerting management for potential impact to the company’s policies.
• Engage in collaborative projects in support of other areas in the company.

Preferred candidates should possess strong knowledge of relevant legal decisions, claim trends and industry practices.

Requirements:

• Bachelor’s Degree from a four-year college
• At least 5 -7 years in handling managed care claims
• JD is highly desirable
• Proficiency with Excel, Word and demonstrated aptitude with Windows based operating systems

Position may be located in Hartford, CT or Boston, MA