Clinical Claims Adjuster- Bayfront

Position Summary The Claims Adjuster manages a case load of third-party claims made against the organization, with a focus on medical professional and general liability claims.

Facility : Bayfront Location : St. Petersburg Type : Full Time Shift : Mon-Fri Responsibilities Essential Functions Identifies actual and potential third-party claims against the organization with a focus on professional and general liability claims, but may also include assistance with property, auto and other types of claims.

Responsible for the coordination of a complete investigation and evaluation of all assigned claims and works closely with assigned legal counsel and Claims leadership to develop strategy to resolve or defend the claim.

Utilizes claims management and loss reduction techniques in negotiating and settling claims that can be resolved without legal counsel involvement.

Participates in setting initial reserves and making recommendations for changes to reserves on all assigned claims in conjunction with the Claims leadership.

Responsible for establishing and maintaining claim files with detailed documentation of all significant claims’ activity and correspondence with legal team and insurance carrier.

Achieves an open trusting relationship with and acts as a liaison between Orlando Health team members, physicians and assigned legal counsel from initiation of claim through settlement and / or trial.

Coordinates activities for each claim with assigned legal counsel including interpretation of medical records, retention of experts, facilitating discovery, performing research, and scheduling of depositions.

Attends all depositions involving Orlando Health physicians, residents and team members. Attends mediation for all assigned claims.

At times, attends mediation as the representative for Orlando Health as directed by Claims leadership with an agreed authority to settle the claim.

Fully participates in trial activities to include focus groups, witness preparation, development of trial exhibits, and attendance at trial.

Qualifications Education / Training Bachelor’s degree in healthcare (preferred), business or closely related fieldEssential Functions Identifies actual and potential third-party claims against the organization with a focus on professional and general liability claims, but may also include assistance with property, auto and other types of claims.

Responsible for the coordination of a complete investigation and evaluation of all assigned claims and works closely with assigned legal counsel and Claims leadership to develop strategy to resolve or defend the claim.

Utilizes claims management and loss reduction techniques in negotiating and settling claims that can be resolved without legal counsel involvement.

Participates in setting initial reserves and making recommendations for changes to reserves on all assigned claims in conjunction with the Claims leadership.

Responsible for establishing and maintaining claim files with detailed documentation of all significant claims’ activity and correspondence with legal team and insurance carrier.

Achieves an open trusting relationship with and acts as a liaison between Orlando Health team members, physicians and assigned legal counsel from initiation of claim through settlement and / or trial.

Coordinates activities for each claim with assigned legal counsel including interpretation of medical records, retention of experts, facilitating discovery, performing research, and scheduling of depositions.

Attends all depositions involving Orlando Health physicians, residents and team members. Attends mediation for all assigned claims.

At times, attends mediation as the representative for Orlando Health as directed by Claims leadership with an agreed authority to settle the claim.

Fully participates in trial activities to include focus groups, witness preparation, development of trial exhibits, and attendance at trial.

Education / Training Bachelor’s degree in healthcare (preferred), business or closely related field