The Doctors Company is currently seeking a Claims Representative for our Region II (Northeast) team. This position is a hybrid or remote position, preferably located in the Central or Eastern time zones.

Position Mission

Responsible for managing MediGuard files, including confirming coverage, monitoring activity, and reviewing expenses to make sure they are appropriate. Work with defense counsel who will keep the Claims Representative updated on cases and advise members regarding status and erosion of limits. Position also includes management of no-fault dental claims and Cyberguard/cybersecurity claims from initiation of the claim through conclusion, working with patients and/or insured members.

Qualifications

• Bachelor’s degree or equivalent combination of education and experience required.
• 3+ years of medical malpractice or equivalent claims-related experience

Responsibilities

MediGuard Management & Claims Resolution

• Manages defense counsel for optimal outcomes.
• Monitors and approves fees and expenses within authority to comply with company guidelines and state statutory guidelines.
• Evaluates and assigns MediGuard matters to defense panel members based on ability and experience.
• Evaluates Attorney work product and advises regional leadership of any need for corrective action or improvement.

No-Fault Dental Claims

• Manage no fault dental claims from claim initiation through resolution.
• Confirms coverage, evaluates medical records, and secure expert review when necessary, working with patients and insured members on resolution strategy.

Cyberguard/Cybersecurity Claims

• Confirm coverage and interface with the insured member and defense counsel through resolution.

Claims Guidelines (Reserve Management, File Documentation Management)

• Maintains a broad-based understanding of the company standards and guidelines.
• Articulates the guidelines to both internal and outside customers, as necessary.
• Seeks to actively meet the expected standards and guidelines in all phases of their work product.
• Uses appropriate judgment in applying guidelines to achieve the desired outcome.
• Monitors and approves fees and expenses within authority to comply with company guidelines and state statutory guidelines.
• Evaluates attorney work product/performance and advises supervisor of any need for corrective action or improvement.

Member Service

• Provide clear communication to members and follow up as necessary based on expectations agreed to with the member and in alignment with the company standards.
• Maintain awareness of member’s needs through regular communication and provide proper support. Utilize all available resources to meet these needs as soon as possible.
• Elevate concerns expressed by the members to management, as necessary.
• Provide high quality, work-product and comprehensive communication that facilitates efficient, and effective downstream workflow.
• Address and escalate service issues/concerns as needed.

Internal / External Customer Collaboration & Support

• Professional manner necessary to achieve the best possible outcome.
• Professionally engages both internal and external customers, when necessary, without prompting.
• Uses internal resources to assist with problem solving.
• Develop trust with stakeholders by making themselves available, as necessary.
• Gives information to stakeholders sufficient to enable them to make informed decisions.

Other duties as assigned

• Makes oneself available for all duties.
• Accepts delegated tasks/duties readily and completes as directed.

Salary Range: $65,914 - $76,899

Compensation varies based on skills, knowledge, and education. We consider factors such as specialized skills, depth of knowledge in the field, and educational background to ensure fair and competitive pay.

Benefits:

The Doctors Company offers competitive compensation, incentive bonus plans, outstanding career opportunities, an exceptional work environment, and an impressive benefits package, which starts with medical, family and bereavement leave; same-sex domestic partner benefits; short- and long-term disability programs; and an employee assistance program. There's more:

• Health, dental, and vision insurance
• Health and dependent care tax-free spending accounts with a company match
• 401(k) and Roth IRA with company match, as well as catch-up plans for both
• Paid vacation, sick days, and personal days each calendar year (with vacation increases based on length of service)
• 12 paid holidays each calendar year
• Life and travel insurance
• Tax-free commuter benefits
• In-person and online learning opportunities
• Cross-function career opportunities
• Business casual work environment
• Time off to volunteer
• Matching donations to qualifying nonprofit organizations
• Company-sponsored participation at non-profit events

About The Doctors Company

The Doctors Company is the nation’s largest physician-owned medical malpractice insurer. Founded and led by physicians, we are committed to advancing, protecting, and rewarding the practice of good medicine.

The Doctors Company is proud to be Certified™ by Great Place to Work®.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.