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Physicians Insurance A Mutual Company has been providing professional liability solutions to physicians, physician groups, and hospitals for more than four decades and is the largest insurer of physicians and rural critical-access hospitals in the Pacific Northwest. The company also provides excess, reinsurance, provider excess, health plan reinsurance and employer medical stop loss solutions. Insurance offerings are paired with risk management, claims, litigation peer support and legal defense services which embody the company’s commitment to providing the strongest possible protection for policyholders and rigorously defending the practice of quality medicine. Through Physicians Insurance Risk Retention Group LLC, Physicians Insurance is expanding its offerings strategically nationwide. Both Physicians Insurance and Physicians Insurance RRG are rated A- (Excellent) by A.M. Best.
The Claims Manager is responsible for leadership and supervision of Senior Claims Representatives and Claims Representatives, for contributing to Claims Department management team activities, and for designated back up and relief duties to the Vice President – Claims. The position also is responsible for caseload tasks including performing claims investigation, settlement, administrative, and technical functions; for monitoring designated Claims Department activities; and for claims-related relationships with physicians, reinsurers, auditors, other insurance companies, attorneys, and other organizations.
Responsibilities include but are not limited to the following:
- Direct and supervise the Senior Claims Representatives and Claims Representatives. This includes responsibility for the Senior and Claims Representatives' training programs and on-the-job training tasks.
- Perform claim investigation, settlement, and negotiations activities. This includes responsibility for taking calls and responding to member inquires, participating in Claims and Policyholder/Member Committee meetings, and for initiating and maintaining relations with consulting physicians, expert witnesses, and defense counsel.
- Consult with and provide insights to Senior Claims Representatives and Claims Representatives assigned to claims; work with reinsurers; and keep the Senior Vice President – Claims advised of new developments or opportunities.
- Identify potential coverage issues and work with Senior Claims Representatives to ensure timely submission for review.
- Provide that designated day-to-day Claims Department activities are conducted in compliance with federal, state, and local laws and regulations, and with the organization's policies and procedures.
- Contribute to the periodic review and updating of Claims Department organization plans, purposes, services, goals, and objectives.
- preparations and attending meetings, depositions, and mediations via videoconferencing or in person as determined by location, needs of account, and/or Court requirements.
- A 4-year college degree or equivalent work experience
- State adjuster licensure
- Eight plus years of professional medical liability claims experience with a history of increasing claims responsibility and authority
- Three years of management experience is strongly preferred
- Demonstrated Leadership skills
- Excellent analytical and detail-oriented skills
- Excellent investigation, research, and negotiation skills
- Demonstrated time management and prioritization skills
- Demonstrated knowledge of insurance policies and coverages
- Strong commitment to customer service, quality, and working in a collaborative team environment
- Excellent interpersonal, verbal, and written communication skills. Ability to present effectively to large or small groups.
- Demonstrated technical ability to work with Microsoft Office, ShareFile and Adobe Acrobat Pro
- Ability to travel in person as determined by location, needs of account, and/or Court requirements
- Availability before or after traditional office hours if a need arises