Senior Resolution Specialist- Medical Malpractice- Hospital and Physician Claims
5847 San Felipe
- $160,000 p/year
- Healthcare
- medical malpractice claims
- claims management
- hospital claims
The Senior Resolution Specialist manages medical malpractice claims involving hospitals and physicians, handling the full lifecycle from coverage analysis to settlement negotiation. This role requires expertise in claims investigation, legal understanding of relevant case law, and the ability to interact with clients, attorneys, and insurers. The position supports effective claim resolution while adhering to industry standards, regulatory requirements, and company policies.
Overview
Salary: up to $160,000 per year, dependent upon experience
Jurisdictions: Open to Any
Licenses: must be willing to obtain all licenses stated by manager within specified timeframe
Location: This role is eligible for fully remote work.
Claims Background: Medical Malpractice - Hospital and Physician Claims Management
How you'll make an impact
- Analyzes coverage and settles moderately complex claims in one or more of Gallagher Bassett's specialty claims areas (Medical Malpractice).
- Generally, incumbent does not work on workers compensation claims.
- Able to manage the full-life cycle of all assigned claims files.
- Analyzes coverage and determines defense obligations.
- Under minimal supervision, conducts thorough analysis and investigations necessary to determine claims exposure and recommend appropriate settlement strategies and action plans.
- Creates reservation of rights and coverage denial letters.
- Negotiates settlements with clients, client attorneys, and Public Adjusters.
- Interacts extensively with various parties involved in the claims process, and may recommend retaining the advice of outside experts as necessary.
- Prepares reserve and settlement authority requests for client and carrier approval.
- May act as a client advocate with carriers to ensure proper claims handling, including any necessary scoping, estimating, and addressing of coverage.
- Has a solid understanding of claims processing and the insurance brokerage business.
- Has a basic understanding of the terminology and case law associated with their specialized claims niche/industry.
- Handles claims consistent with clients' and corporate policies, procedures and best practices and also in accordance with any statutory, regulatory and ethical requirements.
- Incumbents at this level should be able to work at full case load capacity.
About You
Potential candidates should have the following:
- Claims Background: Medical Malpractice - Hospital and Physician Claims Management
- Jurisdictional Experience: Open to any
- Active Adjusters' licenses: must be willing to obtain all licenses stated by manager within specified timeframe
Required:
- High school diploma and 5 years related claims experience required.
- Prior experience working within the applicable specialty claims area or demonstrated ability to handle unique/challenging claims issues.
- Appropriately licensed and/or certified in all states in which claims are being handled or able to obtain the licenses/certification per local requirements.
- Knowledge of accepted industry standards and practices.
- Computer experience with related claims and business software.
Preferred:
- Bachelor's Degree preferred.
- Two or more years of prior experience adjusting claims in applicable specialty area preferred.
- Law Degree (JD) Highly preferred.
- Litigation Experience
Behaviors:
- Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges.
- Analytical skill necessary to make decisions and resolve issues inherent in handling of claims.
- Ability to successfully negotiate the settlement and disposition of claims including the ability to interpret related documentation.
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