Complex Litigation Claims Adjuster II

Presbyterian is seeking a Complex Litigation Claims Adjuster II that investigates, evaluates, and negotiates more severe and complex claims and litigation to a successful resolution and in compliance with company standards. This position will have a strong background in the claims/litigation process and familiarity with all lines of PHS insurance/claim types. The complex litigation claims adjuster must demonstrate strategic thinking and sound decision-making.

Claim types include primarily medical malpractice but may include such claims as Directors and Officers, general and premises liability, property damage exposures of a more severe and complex nature. Maintains claims database documentation, appropriate reserving and case strategy. At the direction of the risk director and risk attorney, directs PHS participation in defense of claims and litigation.

Experience managing and resolving high severity injury claims and litigation, proven skills in time management and caseload management, and must be able to document claim files by accurately capturing and updating claims data/information in compliance with best practices.

Provide general assistance and support to risk management and legal activities.

 

• This is a Full Time (1.0 FTE) position - Exempt: Yes
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days

• Bachelors degree required, 6 years of equivalent experience may be substituted in lieu of degree.
• 5 years of experience managing medical malpractice, general liability, property/casualty claims and litigation including some experience with high severity claims
• 5 years relevant experience in managing complex claims litigation and settlement.
• Licensed Adjuster- State of NM or eligible for licensure in NM
• Some graduate school and/or professional industry designation (ARM, AIC) preferred.
• Paralegal certification preferred
• Requires knowledge of legal issues, data management and interpretation, and effective communication skills
• Ability to multi-task while maintaining discretion, confidentiality, and accuracy/due diligence.
• Strong computer skills with a penchant to adapt easily to learning new software.

• Manage claims and litigation matters from inception to closure including identification and investigation of coverage, liability and damages issues.
• Manage highly complex high exposure liability claims and litigation involving medical malpractice, bodily injury, property damage, personal injury, and advertising injury.
• Establish and execute appropriate and economical plan for claim resolution in compliance with department/carrier best practices and guidelines.
• Review, analyze, research, and prepare responses for discovery.
• Gather, organize and index requested documents including electronic discovery for interrogatories, requests for production, subpoena, and motions.
• Draft frequent and complex claim related correspondence.
• Prepare claim reports and educates organization about risk issues identified through claims data.
• Attend and participate in settlement negotiations and negotiates within authority; attends mediation and trials related to claims or litigation.
• Manage relationships and provides support for internal and external customers.
• Serve as primary source of contact and support for employees named or involved in claims/lawsuits.
• Consistently demonstrate comprehensive coverage analysis, investigation, evaluation, negotiation skills at an advanced level.
• Direct and control activities of outside vendors, including defense counsel and experts.
• Other duties as assigned.

About Presbyterian Healthcare Services

Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.

 

The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities—like challenges, webinars, and screenings—with opportunities to earn gift cards and other incentives.

 

As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships.

Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.

 

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

USD $49.26/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.