Manager Medicaid Claims Processing Jobs in Indiana

Job Title: Claims Attorney

FLSA Status: Exempt

Job Family: Claims

Department: Casualty Claims

Location: Corporate Office (Fort Wayne, IN)

JOB SUMMARY

Effectively analyze and resolve serious/complex claims and/or litigation consistent with department standards and company objectives. Responsible to advise claims and other company personnel on legal issues relating to claims; communicate legal information to internal and external contacts as directed. Complete assigned legal research projects in a timely and effective manner.

POSITION ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Identify and investigate coverage, liability, damage, and possible exposure issues on claims.
• Analyze and address insurance coverage issues and claims legal research issues and recommend claims resolution strategies.
• Apply and/or provide guidance to claims personnel concerning the application of policy language, statutes, common law, and other applicable legal and regulatory concepts for effective, efficient, and equitable resolutions.
• Communicate with policyholders, agents, adjusters, claimants/claimant attorneys, defense counsel, and other persons and entities as needed to ensure claims resolution.
• Acquire, record, and maintain all essential file documentation in accordance with established guidelines, including the timely provision of status reports or other updates as requested by management.
• Identify and/or offer guidance regarding appropriate cost containment, loss mitigation, and subrogation recovery opportunities.
• Negotiate and resolve serious/complex claims and/or litigation within established settlement authority in a prompt, fair and equitable manner.
• Effectively and efficiently undertake routine legal document review and analysis and draft releases, coverage letters, and other claims-related documents for the claims department.
• Contribute as requested to departmental or interdepartmental projects or processes that relate to the claims function, including regularly scheduled meetings involving collective decision-making.
• Travel as needed to conduct claims-related investigations and attend training programs, mediations, trials, and other legal proceedings related to the resolution of serious/complex claims and/or litigation.
• Understand the claims department’s reserving practices and offer guidance regarding reserving as needed.
• Effectively, efficiently, and fairly bring serious/complex claims and/or litigation to resolution and achieve company objectives for Loss Adjustment Expense.
• Ensure the security and accuracy of checks issued through the claims processing system.
• Complete other projects as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES

The requirements listed below are representative of the knowledge, skills, and/or abilities required to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Demonstrate expertise in communicating complex coverage and legal concepts in both an oral and written format.
• Possess knowledge relating to litigation and tort, contract, and insurance law. Must be able to conduct effective legal research.
• Must have a thorough understanding of pertinent coverage and complex legal issues related to claims.
• Demonstrate strong organizational, analytical, prioritization, and time management skills.
• Possess strong negotiation and resolution skills, utilizing them in the resolution of serious/complex claims and/or litigation.
• Demonstrate a thorough understanding of all automated claim department processing systems, workflows, and the claims department policies and procedures.
• Possess legal drafting skills.
• Must be able to sit for prolonged periods of time.
• Effectively interface with external contacts, Brotherhood employees, managers, and department staff members.

EDUCATION AND/OR EXPERIENCE

• Must have a Bachelor’s degree and a JD degree.
• Must be able to take and pass required adjuster licensing requirements.
• Must have one to two years of general business, insurance, or related experience.
• CPCU or other insurance-related coursework is desired.
• Member of at least one State Bar is desired.
• Two years of legal research and writing experience are desired.
• Experience in investigation, customer service, and/or negotiation fields is desired.

Terms and Conditions

This description is intended to describe the general content of and requirements for the performance of this position. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.

Because the company’s niche is the church and related ministries market, and because effective service requires a thorough understanding of this market, persons in this position must be familiar with church operations and must conduct themselves in a manner that will neither alienate nor offend persons within this target niche.

Brotherhood Mutual Insurance Company reserves the right to modify, interpret, or apply this position description in any way the company desires. This job description in no way implies that these are the only duties, including essential duties, to be performed by the employee occupying this position. This position description is not an employment contract, implied or otherwise. The employment relationship remains “at-will”.