Claims Adjuster

About This Role

This role involves managing a caseload of third-party claims against the organization, with a primary focus on medical professional and general liability claims. The Claims Adjuster coordinates investigations, develops resolution strategies with legal counsel, and acts as a liaison between Orlando Health team members, physicians, and legal counsel throughout the claims process.

Responsibilities

• Identify actual and potential third-party claims against the organization, focusing on professional and general liability, and assist with property, auto, and other claim types
• Coordinate a complete investigation and evaluation of all assigned claims
• Work closely with assigned legal counsel and Claims leadership to develop claim resolution or defense strategies
• Utilize claims management and loss reduction techniques in negotiating and settling claims without legal counsel involvement
• Participate in setting initial reserves and recommend changes to reserves on all assigned claims in conjunction with Claims leadership
• Establish and maintain claim files with detailed documentation of all significant claims activity and correspondence with the legal team and insurance carrier
• Achieve an open, trusting relationship with and act as a liaison between Orlando Health team members, physicians, and assigned legal counsel from claim initiation through settlement and/or trial
• Coordinate activities for each claim with assigned legal counsel, including interpretation of medical records, retention of experts, facilitating discovery, performing research, and scheduling depositions
• Attend all depositions involving Orlando Health physicians, residents, and team members
• Attend mediation for all assigned claims
• Attend mediation as the representative for Orlando Health as directed by Claims leadership with agreed authority to settle the claim
• Fully participate in trial activities, including focus groups, witness preparation, development of trial exhibits, and trial attendance
• Manage Department of Health licensure investigations involving employed physicians and team members in conjunction with assigned legal counsel
• Act as a liaison between Orlando Health physicians/team members and assigned legal counsel and assist with formulating responses to the DOH
• Attend board meetings of licensing agencies with physicians or team members and legal counsel if a settlement agreement is reached with the board
• Review all legal bills and other invoices for compliance with litigation plans and approve for payment
• Prepare and update reports on all assigned claims that demonstrate resolution strategy
• Attend and participate in internal claims team meetings, scheduled attorney meetings, claims strategy meetings, and pre-mediation meetings