Claim Manager

Position Summary

Remote or Hybrid

The Claim Manager owns an assigned inventory of medical professional liability and related claims from initial notice through final resolution. Working within delegated authority and established claims procedures, this role investigates and evaluates claims, maintains appropriate reserves, coordinates litigation and resolution activity, and provides responsive service to insured healthcare professionals and organizations.

The Claim Manager recognizes potential legal, coverage, regulatory, and compliance issues and promptly escalates them to company leadership or legal counsel, as appropriate. The role collaborates closely with defense counsel and other subject matter experts but does not independently provide legal advice or act as company counsel.

What You Will Do

· Manage an assigned inventory of claims and incidents from initial receipt through final disposition, taking timely action at each diary interval and maintaining complete, accurate, and contemporaneous electronic file documentation.

· Handle matters in accordance with applicable policies, laws and regulations, company procedures, delegated authority, and current claims guidelines.

· Review new notices and available policy information; identify potential coverage concerns, reservation-of-rights issues, or other matters requiring legal or leadership review; and escalate them promptly for direction.

· Gather and assess factual, medical, financial, and litigation information relevant to liability, causation, damages, venue, potential exposure, and resolution options, consulting with counsel or other specialists when legal or clinical judgment is required.

· Establish or recommend timely indemnity and expense reserves within delegated authority, document the supporting rationale, and update reserves as material information changes.

· Conduct regular reviews of every assigned open file to assess reserves, investigation or litigation status, current strategy, and next actions.

· Select and engage qualified investigators, defense counsel, consultants, and experts in accordance with company procedures; provide clear assignments and monitor performance, strategy, reporting, budgets, fees, and invoices.

· Review pleadings, discovery, medical records, expert reports, investigation materials, evaluations, and litigation budgets; identify follow-up needs and coordinate strategy with defense counsel and internal leadership.

· Prepare timely claim reports, summaries, reserve and settlement recommendations, management reports, and other required documentation.

· Communicate candidly and professionally with insureds, management, reinsurers, regulators, Finance, and other stakeholders while safeguarding confidential and protected information.

· Serve as a primary claims contact for insureds, explain claim status and the approved strategy, coordinate responses to pre-suit matters and litigation activity, and respond promptly to questions and concerns.

· Identify and evaluate settlement opportunities; participate in negotiations within delegated authority and in coordination with defense counsel; and prepare well-supported requests for additional reserve or settlement authority.

· Promptly escalate policy-limit, excess, time-sensitive, reputational, high-severity, or otherwise significant matters in accordance with company procedures.

· Attend mediations, settlement conferences, significant depositions, hearings, trials, insured meetings, and claim reviews when appropriate, including travel or work outside normal business hours when claim needs require.

· Monitor indemnity and expense payments and confirm that authority, supporting documentation, releases, closing materials, reinsurance communications, and system entries are complete before a file is closed.

· Partner with insureds and internal teams on claim trends, early-intervention opportunities, loss-prevention insights, education, and service improvements without providing legal advice.

· Develop subject matter knowledge in an assigned claims or operational area, such as the handling of protected health information, and help maintain practical guidance, processes, and training in coordination with Legal, Compliance, or other responsible functions.

· Participate in claim committee and departmental meetings; collaborate with Underwriting, Risk Management, Finance, Claims Administration, and other business partners; and support training, mentoring, and special projects as requested.

What You Bring

· Bachelor's degree or an equivalent combination of education and relevant experience.

· Relevant experience managing medical professional liability, healthcare, complex casualty, or similarly complex claims; comparable healthcare litigation or insurance experience may also be considered.

· Working knowledge of claim investigation, civil litigation processes, reserving, negotiation, litigation budgeting, and settlement evaluation.

· Ability to synthesize complex medical, legal, financial, and factual information; recognize issues that require specialized review; and make sound claim-management decisions within delegated authority.

· Demonstrated ability to manage a substantial caseload, competing deadlines, and detailed documentation while maintaining timely follow-through.

· Clear, professional written and verbal communication with insureds, counsel, leaders, vendors, and other stakeholders.

· High standards of integrity, confidentiality, organization, collaboration, customer service, and financial stewardship.

· Ability and willingness to travel and occasionally work outside normal business hours when claim or insured needs require.

Preferred Qualifications

· Experience with medical malpractice or professional liability claims involving physicians, hospitals, or other healthcare organizations.

· Familiarity with insurance coverage concepts, reinsurance reporting, healthcare privacy requirements, and regulated claim environments.

· Professional certifications such as RPLU, CPHRM, CPCU, AIC, or comparable credentials.

· A Juris Doctor degree or active law license may be helpful for some candidates but is not required; this is a claim-management position, not a claim-counsel role.

Work Environment

This is a full-time position that may be performed remotely or in a hybrid arrangement, subject to business needs and company policy. The role requires regular use of a computer and telephone, sustained attention to detailed information, and periodic travel for claim-related activities. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Additional Information

This description summarizes the general nature and level of work expected for the position. It is not an exhaustive list of responsibilities, duties, or qualifications, and responsibilities may change based on business needs. Employment is subject to applicable company policies and legal requirements.

We are an equal opportunity employer and consider qualified applicants without regard to race, color, religion, sex, pregnancy, national origin, age, disability, genetic information, veteran status, or any other status protected by applicable law.

Please email your resume to:

Leslie Jeffries, Director of Human Resources

ljeffries@hsg-group.com

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Health savings account
• Life insurance
• Matching gift program
• Paid time off
• Parental leave
• Professional development assistance
• Retirement plan
• Tuition reimbursement
• Vision insurance

Work Location: Hybrid remote in Jefferson City, MO 65109