Thomas Jefferson University & Jefferson Health
Senior Complex Claims Adjuster, Center City - Full Time
Thomas Jefferson University & Jefferson Health, Phila, Pennsylvania, United States, 19117
About JeffersonNationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow#39;s professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering
200+
undergraduate and graduate programs to more than
8,300 students.
Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at
32 hospitals campuses
and
more than 700 outpatient and urgent care locations
throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.Jefferson is committed to providing equal educashy;tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.Covid Vaccination is a requirement for employment at Jefferson for employees working at Jeffersonrsquo;s clinical entities or at the University. If you are not currently vaccinated you will be required to receive the vaccination prior to hire date if you are offered employment, unless you request and receive an approved medical or religious exemption from Jefferson.Minimum Education and Experience Requirements:Education:Bachelorrsquo;s degreeANDExperience:A minimum of 7 years of complex professional liability claims management experience required. 10 years preferred.Minimum Certifications, Registration or License Requirements:AIC encouragedCompetencies (Knowledge, Skills, and Abilities Required):Possess a strong knowledge of the legal system, litigation, claims trends, and industry practices.Superior negotiation skills within a litigation and non-litigation context.Proficiency with claims information management systems (CIMS), Excel, Word, and demonstrated aptitude with Windows-based operating systems.Strong presentation, interviewing, investigation, and negotiation skills.Ability to budget own time effectively. Refers cases as appropriate to supervisor and management.Ability to work in a team environment.Occasional work travel.Job SummaryWorking under the general supervision of the Director of Claims and Insurance, responsible for handling all aspect of the highest exposure and miscellaneous professional liability claims, including class actions and high exposure matters, from inception through conclusion brought against Jefferson. This position also includes process development and training support for younger claims professionals in the Claims Department.
Essential FunctionsInteracts with co-workers, visitors, and other staff consistent with the values of Jefferson.Analyze, determine, and communicate the appropriate coverage position. Effectively manage litigation by evaluating liability and damages and determining the appropriate course of action for case resolution through well-developed action plans. Negotiate claims settlements up to designated authority level.Work with Director of Claims and Insurance in the development of Enterprise litigation responses to discovery and other legal objections and requirements as requested.Coordinates legal defense by assigning attorneys, coordinating support for the investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. Assist Director of Claims and Insurance in the conducting of defense counsel file reviews as requested.Handle claims consistent with Mountain Laurel Risk Retention Group (MLRRG,) and corporate policies, procedures, and standard methodologies following statutory, regulatory, and ethics requirements. Maintain accurate documentation in the claim file and adhere to claim documentation standards.Uses appropriate cost containment techniques, including strategic vendor partnerships to reduce overall claim costs for the organization.Calculates and assigns timely and appropriate financial reserves to claims, monitors reserve adequacy throughout claim life.Assist Director of Claims and Insurance in the development, implementation and training of new claims and litigation management procedures as needed.Prepare reports to senior leadership which address liability exposure, coverage issues, litigation strategies, and loss development.Works with other adjusters to evaluate files, to assist them in making reserve recommendations and to learn the jurisdiction requirements as requested by the Director of Claims and Insurance.Represents Company in depositions, mediations, and trial monitoring as needed.Interact with other internal departments and external organizations, including underwriting, actuarial, finance, and operations as neededOther duties as assigned.
200+
undergraduate and graduate programs to more than
8,300 students.
Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at
32 hospitals campuses
and
more than 700 outpatient and urgent care locations
throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.Jefferson is committed to providing equal educashy;tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.Covid Vaccination is a requirement for employment at Jefferson for employees working at Jeffersonrsquo;s clinical entities or at the University. If you are not currently vaccinated you will be required to receive the vaccination prior to hire date if you are offered employment, unless you request and receive an approved medical or religious exemption from Jefferson.Minimum Education and Experience Requirements:Education:Bachelorrsquo;s degreeANDExperience:A minimum of 7 years of complex professional liability claims management experience required. 10 years preferred.Minimum Certifications, Registration or License Requirements:AIC encouragedCompetencies (Knowledge, Skills, and Abilities Required):Possess a strong knowledge of the legal system, litigation, claims trends, and industry practices.Superior negotiation skills within a litigation and non-litigation context.Proficiency with claims information management systems (CIMS), Excel, Word, and demonstrated aptitude with Windows-based operating systems.Strong presentation, interviewing, investigation, and negotiation skills.Ability to budget own time effectively. Refers cases as appropriate to supervisor and management.Ability to work in a team environment.Occasional work travel.Job SummaryWorking under the general supervision of the Director of Claims and Insurance, responsible for handling all aspect of the highest exposure and miscellaneous professional liability claims, including class actions and high exposure matters, from inception through conclusion brought against Jefferson. This position also includes process development and training support for younger claims professionals in the Claims Department.
Essential FunctionsInteracts with co-workers, visitors, and other staff consistent with the values of Jefferson.Analyze, determine, and communicate the appropriate coverage position. Effectively manage litigation by evaluating liability and damages and determining the appropriate course of action for case resolution through well-developed action plans. Negotiate claims settlements up to designated authority level.Work with Director of Claims and Insurance in the development of Enterprise litigation responses to discovery and other legal objections and requirements as requested.Coordinates legal defense by assigning attorneys, coordinating support for the investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. Assist Director of Claims and Insurance in the conducting of defense counsel file reviews as requested.Handle claims consistent with Mountain Laurel Risk Retention Group (MLRRG,) and corporate policies, procedures, and standard methodologies following statutory, regulatory, and ethics requirements. Maintain accurate documentation in the claim file and adhere to claim documentation standards.Uses appropriate cost containment techniques, including strategic vendor partnerships to reduce overall claim costs for the organization.Calculates and assigns timely and appropriate financial reserves to claims, monitors reserve adequacy throughout claim life.Assist Director of Claims and Insurance in the development, implementation and training of new claims and litigation management procedures as needed.Prepare reports to senior leadership which address liability exposure, coverage issues, litigation strategies, and loss development.Works with other adjusters to evaluate files, to assist them in making reserve recommendations and to learn the jurisdiction requirements as requested by the Director of Claims and Insurance.Represents Company in depositions, mediations, and trial monitoring as needed.Interact with other internal departments and external organizations, including underwriting, actuarial, finance, and operations as neededOther duties as assigned.