MICA remains committed to creating an inclusive environment that values and respects the diverse talents, skills, and backgrounds of everyone. We celebrate both our differences and our similarities as we focus on service to our members and foster shared opportunities in furtherance of MICA's mission.
MICA features a challenging and professional work environment characterized by open communication, business casual working attire and flexible work schedules. We always welcome inquiries regarding employment opportunities with the company.
We offer a competitive compensation package and a comprehensive benefits program that supplements our pro-active employee focus. We also support professional growth opportunities to ensure employees are equipped with the knowledge, skills and abilities to provide exemplary client service.
Role Overview
The Claim Representative is responsible for investigating, managing, and evaluating minimal to high exposure claim and suit files in accordance with Claim Department Guidelines, to include identifying coverage issues, setting adequate reserves, assessing the degree of liability and determining case value. The Claim Representative brings cases to a satisfactory close, including negotiating settlements. The Claim Representative works closely with the assigned supervisor.
Responsibilities
In the interest of cybersecurity, the Claim Representative is responsible for being cautious and vigilant when opening emails, attachments etc. on MICA’s equipment, and smartphones that are connected to MICA’s email systems. Likewise, it is the Claim Representative’s responsibility to complete cybersecurity training modules that are periodically distributed by MICA’s IT department.
Initial Claim Handling:
- Take first notices.
- Review first notice and instructions (and Summons & Complaint when applicable).
- Review claim for potential coverage issues.
- Discuss questions on claim handling and coverage with supervisor, as necessary.
- Select defense counsel with appropriate supervisory input and after discussion with Insured.
- Make service provider and reserve recommendations.
- Prepare correspondence to Insured and counsel.
- Report claims to NAS and/or regulatory Boards, if appropriate.
Claim File Work-up:
- Obtain and appropriately organize medical records.
- Review medical records and appropriate literature.
- Interview Insured and prepare interview summary.
- Interview unrepresented claimants and prepare summary.
- Obtain/review pertinent records of subsequent treating physicians, as necessary.
- Select and approve standard of care and causation consultants.
- Attend key depositions.
- Discuss defense strategy with assigned counsel.
- Prepare file for 90-day supervisory review by identifying liability issues and damages, considering reserves, and act on requests for follow up.
- Obtain information on liens and Medicare Right of Recovery.
- Monitor reserves.
- Prepare timely reports to management and/or reinsurers.
- Evaluate defensibility, verdict range and settlement value.
- Prepare and present appropriate cases to management for settlement authority.
- Make timely and accurate claim file entries documenting developments.
- Enter pertinent information into the data-capture systems.
- Promptly review, code and pay bills.
Claim Resolution:
- Discuss settlement with Insured and obtain proper written consent.
- Log all trial and mediation dates into the data capture system.
- Prepare Request for Authority and present at the appropriate management level.
- Attend MICA Authority Committee Meeting, if necessary.
- Prepare strategy for negotiations.
- Attend mediations or negotiate directly with the claimant or claimant’s attorney.
- Prepare and present pre-trial report.
- Monitor trial and notify management of pertinent developments.
- Prepare check request for trial reimbursement to insured.
- Prepare indemnity check request and routing instructions.
- Enter settlement, verdict and/or expert information into the data capture system.
- Prepare accurate report to the National Practitioner Data Bank, for supervisory review.
- Report settlement to appropriate regulatory entity and/or Medicare, if appropriate.
- Obtain copy of Release, Dismissal and final bills.
- Send closing letter to Insured.
- Timely close file after final payments, reports and closing documents are received.
Minimum Requirements
- High School diploma or GED; Bachelor’s degree preferred.
- Minimum of 3 years, progressively complex casualty/property claims experience.
- Must demonstrate good judgment.
- Excellent oral and written communication skills.
- Well organised and detail oriented.
- Able to work independently in a telecommuting environment, if appropriate.
- Able to develop effective working relationships.
- Able to keep sensitive information confidential.
- Working knowledge of personal computers and computer applications.
- Must have a valid driver’s licence and must be able to meet MICA’s insurability requirements.
- Field experience preferred.
- 25% travel required.
- Medical, Dental, and Vision Insurance
- Flexible Spending Accounts
- Basic Employee Life Insurance - paid 100% by MICA
- Optional Life Insurance
- Personal Accident Insurance
- Short- and Long-term Disability
- Self-directed 401(k) with a generous company matching program
- Defined benefit retirement plan
- Paid vacations and holidays
- Tuition Reimbursement for approved educational courses
- Employee Assistance Program
- Relocation Assistance for certain positions
- Insurance coverage is offered for employees, family members, and partners.
Bring your talents to MICA. We recognize that the best-qualified individuals, contributing their ideas and expertise, will enable us to continue our successful support of the healthcare community.
Disclaimer: The benefits identified herein and the eligibility of employees, family members, and partners are governed by the applicable plans. The company, in its sole discretion, and in accordance with applicable law, reserves the right to change and/or delete any or all of the above-listed benefits at any time.
This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to access and analyze data more easily.
NOTE to employment agencies and search firms: Please do not forward resumes to this website. Your company's literature may be sent to MICA at the following address. MICA will not be responsible for any fees arising from the use of resumes received through this site.
Note to applicants and employment agencies: General letters of intent without a detailed resume will not be considered. MICA will also not consider unsolicited letters of intent with or without resumes.
MICA is an Equal Opportunity Employer.