Manages claims and litigation activities, including coverage analysis, reserves, liability evaluation, settlements, defense counsel oversight, audits, policies, workflow, reporting, and staff performance. The role supervises claims professionals handling medical malpractice and severe bodily injury claims, ensures regulatory and company compliance, supports training and strategic planning, and advises leadership on claim status and settlement decisions.
The Manager, Claims is responsible for all claims and litigation management activities for the claims professional staff. They will monitor the file handling and reserve setting by assigned staff as well as oversee and evaluate the work of defense counsel utilized by assigned staff for timely and cost effective case disposition.
Essential Duties & Responsibilities
- Analyze and verify insurance coverage for claims brought against policyholders.
- Assure timeliness and adequacy of reserves on claim files, approve or recommend adjustments as necessary.
- Assign losses to claim staff for disposition of claims.
- Evaluate liability, damages and causation and approves settlements (if appropriate) up to approved limit of authority.
- Advise Claims leadership on claims status and attend Reserve & Settlement Committee Meetings as necessary. Ensure timely reporting to the Reserve and Settlement Committee.
- Determine work procedures, manage work schedules, and expedite work flow.
- Maintain existing and develop new claims policies and procedures to improve the overall function of the department.
- Interact with other departments as necessary to help facilitate and coordinate services to our insured and clients.
- Conduct quarterly audits of consultant case files and ensure that file management guide protocols are current and reflective of proper claim handling practices
- Monitor staff to identify and implement training needs and ensure compliance with the Company claims handling requirements.
- Track and monitor results, recommend improvements and participate in departmental strategic planning.
- Manage assigned staff to include performance evaluations, time off, time card review, recognition and disciplinary issues.
- May monitor trials as necessary.
- As directed, assist Claims leadership in the development of claims related marketing strategies and tools for client retention and new business cultivation.
Education, Requirements & Competencies
- Bachelor's degree (B. A.) from four-year college or university
- 8 years’ experience in handling medical malpractice claims or heavy bodily injury claims preferred
- A minimum of 3 years of supervisory/management experience.
- Must have broad knowledge of medicine and familiarity with legal concepts and trends in litigation. Must be knowledgeable in insurance policy contracts, particularly medical malpractice and general liability.
- Formal nursing and/or legal education is also a plus, but not required.
The base salary range for this role is $132,300 - $178,900. Individual compensation packages are based on a variety of factors that are unique to each candidate including geographic location, skill set, experience, qualifications and education.
If you're a caring and customer focused individual who enjoys working with passionate team members, Coverys is the right company for you!
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