Complex Claims Consultant, Healthcare

Complex Claims Consultant for a specialized line of business in the healthcare industry, managing commercial claims with high complexity and exposure, coordinating claim resolution activities, and achieving quality and customer service standards.

Requirements

• Managing an inventory of highly complex commercial claims
• Ensuring exceptional customer service
• Verifying coverage and establishing timely and adequate reserves
• Leading focused investigation to determine compensability, liability, and covered damages
• Resolving claims by collaborating with internal and external business partners
• Establishing and managing claim budgets
• Realizing and addressing subrogation/salvage opportunities or potential fraud occurrences
• Achieving quality standards
• Maintaining subject matter expertise and ensuring compliance with state/local regulatory requirements
• Mentoring, guiding, developing, and delivering training to less experienced Claim Professionals

Benefits

• Comprehensive and competitive benefits package
• Reasonable accommodations to qualified individuals with disabilities in the recruitment process