Complex Litigation Claims Adjuster I

Now hiring a Complex Litigation Claims Adjuster I

The Complex Litigation Claims Adjuster I investigates, evaluates, and negotiates complex claims and litigation to a successful resolution and in compliance with company standards. This position will have a familiarity with the claims/litigation process and familiarity with all lines of PHS insurance/claim types. The complex litigation claims adjuster must demonstrate strategic thinking and sound decision-making.

Claim types include primarily medical malpractice but may include such claims as Directors and Officers, general and premises liability, property damage exposures. Maintains claims database documentation, appropriate reserving and case strategy. At the direction of the risk director and risk attorney, directs PHS participation in defense of claims and litigation.

Experience managing and resolving claims and litigation, proven skills in time management and caseload management, and must be able to document claim files by accurately capturing and updating claims data/information in compliance with best practices.

Provide general assistance and support to risk management and legal activities

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

Full Time - Exempt: Yes
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

Ideal Candidate:

Associates degree required.

2 years of experience managing medical malpractice, general liability, property/casualty claims and litigation

2 years relevant experience in managing complex medical malpractice claims or clinical provision of healthcare required.

• Associates degree required.
• 2 years of experience managing medical malpractice, general liability, property/casualty claims and litigation
• 2 years relevant experience in managing complex medical malpractice claims or clinical provision of healthcare required.
• Licensed Adjuster State of NM or eligible for licensure in NM
• Paralegal certification preferred
• Requires knowledge of legal issues, data management and interpretation, and effective communication skills
• Ability to multi-task while maintaining discretion, confidentiality, and accuracy/due diligence.
• Strong computer skills with a penchant to adapt easily to learning new software.
  
  

Education Essential: Associate Degree

• Manage litigated claim files from inception to closure including identification and investigation of coverage, liability and damages issues with guidance from the Risk Director and Risk Attorney.
• Manage complex liability claims and litigation involving medical malpractice, bodily injury, property damage, personal injury, and advertising injury.
• Establish and execute appropriate and economical plan for claim resolution in compliance with department/carrier best practices and guidelines.
• Review, analyze, research, and prepare responses for discovery.
• Gather, organize and index requested documents including electronic discovery for interrogatories, requests for production, subpoena, and motions.
• Draft frequent and complex claim related correspondence and claim reports.
• Attend and participate in settlement negotiations and negotiates within authority; attends mediation and trials related to claims or litigation.
• Manage relationships and provides support for internal and external customers.
• Serve as primary source of contact and support for employees named or involved in claims/lawsuits.
• Consistently demonstrate comprehensive coverage analysis, investigation, evaluation, negotiation skills.
• Direct and control activities of outside vendors, including defense counsel and experts with guidance from the Risk Attorney
• Other duties as assigned.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.