Senior Consultant analyzing healthcare payer strategies at Guidehouse. Leading engagements in healthcare strategy and transformation for commercial and federal health sectors.
About the role
- Complex Claims Consultant managing medical malpractice claims for Allied Healthcare Providers. Involves investigation, management, and resolution of claims in multi-state jurisdictions.
Responsibilities
- Manages an inventory of highly complex commercial claims
- Ensures exceptional customer service by managing all aspects of the claim
- Verifies coverage and establishes timely and adequate reserves
- Leads focused investigation to determine compensability, liability and covered damages
- Resolves claims by collaborating with internal and external business partners
- Establishes and manages claim budgets
- Realizes and addresses subrogation/salvage opportunities or potential fraud occurrences
- Achieves quality standards by appropriately managing each claim
- Keeps senior leadership informed of significant risks and losses
- Maintains subject matter expertise and ensures compliance with state/local regulatory requirements
- Mentors, guides, develops and delivers training to less experienced Claim Professionals.
Requirements
- Bachelor's Degree or equivalent experience
- JD a plus
- Typically a minimum six years of relevant experience, preferably in claim handling or medical malpractice litigation
- Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable
- Prior negotiation experience
- Professional designations preferred (e.g. CPCU)
Benefits
- CNA offers a comprehensive and competitive benefits package to help our employees – and their family members – achieve their physical, financial, emotional and social wellbeing goals.
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Consultant in Healthcare Strategy & Transformation at Guidehouse, focusing on healthcare payer organizations and reimbursement structures. Collaborating on data analysis and client deliverables to drive strategic decisions.
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