Senior Claims Administrator

• Associate’s Degree Paralegal studies or other related field.

   

• Florida Health Care Risk Management License
• Five (5) years of medical malpractice and/or professional liability claims experience.

Skills & Abilities:

• In-depth knowledge of claims handling processes, coverage analysis, and litigation management.
• Ability to investigate claims thoroughly, assess liability and damages, and develop effective resolution strategies.
• Understanding of statutory and regulatory requirements in applicable jurisdictions, including Section 111 reporting.
• Strong written and verbal communication skills for negotiating settlements and collaborating with internal and external stakeholders.
• Ability to manage defense counsel, investigators, and vendors within established guidelines and budgets.
• Skilled in claims management systems for documentation, reporting, and analysis.

The Senior Claims Administrator is responsible for managing all aspects of assigned claims, including coverage determination, litigation management, and resolution strategies. This role involves investigating claims, analyzing liability and damages, and ensuring compliance with statutory and regulatory requirements. The administrator works closely with defense counsel, manages vendors and experts, oversees Section 111 reporting, and identifies subrogation opportunities. The position requires strong analytical, negotiation, and communication skills, as well as the ability to work independently in a fast-paced environment while adhering to company guidelines and cost-effective practices.

Essential Functions:

• Administer all aspects of assigned claims, including coverage determination and resolution.
• Investigate claims, review documentation, and maintain detailed analysis of liability and damages.
• Manage litigation with a focus on early resolution and cost efficiency.
• Attend court hearings, mediations, and arbitration proceedings as required.
• Retain and oversee defense counsel, investigators, vendors, and expert witnesses within company guidelines.
• Ensure compliance with statutory and regulatory requirements, including Section 111 reporting.
• Respond to coverage rebuttals and issue declinations when coverage does not exist.
• Identify subrogation opportunities and initiate recovery efforts in collaboration with legal counsel.
• Maintain accurate notes and diaries in the claims management system and adhere to reporting and reserve requirements.
• Participate in audits, file reviews, staff meetings, and training sessions as assigned.