Commercial Representative - Pretoria, South Africa - Career Crew

Career Crew

Verified Company

Pretoria, South Africa

1 week ago

Posted by:

Thabo Mthembu

beBee Recruiter

Description

Job description medical malpractice representative

Summary
Investigates and evaluates complex and severe claims, primarily related to medical malpractice.

Participates in all aspects of a claim file, under the direction of a claim's attorney, including data gathering, investigation, and development of claim summaries and timelines.

Prepares and maintains appropriate documentation in applicable databases and information systems. Prepares claim reports and communicates updated claims information to health system entities, as directed.

Duties and Responsibilities

Assists with and/or directly handles all aspects of a claim file from beginning to conclusion, including the investigation, determination of liability, confirmation of coverage, assessment of damages, and drafting of claim evaluation for recommended action.
Investigates claims, obtains appropriate data, and assembles appropriate medical information and facts regarding claims, including evaluation of clinical charts, interviewing healthcare providers, securing internal reviews, and developing case summaries and timelines.
Utilizes litigation management and claims management information systems to maintain, organize, and retain relevant claims data and files.
Reviews all claims for status of investigation, assessment of liability, documentation of damages, adequacy of reserves, evaluation of expert witnesses, documentation of recent developments and current plan for claim resolution.
Manages relationships and provides support for internal and external customers, serving as a primary source of contact and support for individuals named and/or involved in claims and lawsuits.
Maintains cooperative working relationships with other departments and entities to facilitate quick responses to internal and external customers.
Participates in problem solving and problem resolution.
Identifies trends and opportunities in medical malpractice claims and participates in reporting and communication, as directed.
May assist with efforts to educate campus constituents regarding risk issues identified through claims data to mitigate future liabilities; may assist in the response to discovery requests.
Performs miscellaneous jobrelated duties as assigned.

Education/Skills

Bachelor's degree.
At least five (5) years of experience with insurance claims, selfinsurance, pooled insurance, or Joint Powers of Authorities.
Possess comprehensive knowledge relating to public entity liability claims.
Excellent written and verbal communication skills.

Knowledge, Skills and Abilities Required

Strong investigative and problem resolution skills.
Strong interpersonal skills and the ability to work effectively with a wide range of constituencies in a diverse community.
Knowledge of medical and legal terminology.
Ability to use independent judgment and to manage and impart confidential information.
Ability to develop and maintain recordkeeping systems and procedures.
Knowledge of the judicial system and procedures.
Ability to analyse, interpret and draw inferences from research findings, and prepare reports.
Knowledge of principles, procedures, and standards for drafting a range of complex legal documentation in area of expertise.
Knowledge of current and emerging developments and trends within area of expertise.
Advanced working knowledge of legal research principles, methods, techniques, and resources.
Interviewing and data collection skills.
Ability to work independently and as a member of a team.
Ability to gather and organise legal evidence.
Ability to communicate and interact effectively with practicing physicians and clinical management.
Ability to accurately communicate and record medical, forensic, and legal information received over the telephone and/or in written reports.
Proficiency in the use of computers and Microsoft Office software.
Working Conditions and Physical Effort
No or very limited exposure to physical risk.