07/14/2006 03535

MEDICAL MALPRACTICE COVERAGE SPECIALIST

DEFINITION:

This is technical work in reviewing and examining medical malpractice insurance coverage filings to ensure compliance with medical professional liability insurance laws and regulations.

An employee in this job is responsible for the review and analysis of medical malpractice coverage information to ensure the existence of adequate medical malpractice insurance coverage for health care providers and eligible professional corporations, professional associations and partnerships. Work includes determining the existence of basic insurance coverage; contacting insurance company representatives, attorneys, Department personnel, and other Commonwealth agencies to obtain additional information or other required documentation; calculating assessment and ensuring the appropriate funds are remitted; determining eligibility for the Abatement Program; providing technical assistance to insurance company representatives or health care providers; and maintaining medical malpractice coverage records. Work is performed independently within established policies and procedures. Work is assigned by a technical supervisor who reviews completed work for proper application of laws, regulations and policies.

EXAMPLES OF WORK:

Reviews, analyzes and approves or disapproves medical malpractice insurance coverage filings.

Corresponds with insurance company representatives and health care providers to resolve problems and issues with submitted materials.

Coordinates with the Department of State to report non-compliance issues and to confirm information in Articles of Incorporation.

Provides technical assistance to insurance company representatives in the area of new and renewal business, endorsements, discounts, slot rating, suspensions, cancellations, and experience rating.

Conducts on-site audits of medical malpractice insurance coverage filings, internal documents, and third party materials to ensure accuracy, completeness and compliance with Act 13.

Participates in meetings and develops presentations for insurance carriers in order to promote services provided or explain program requirements.

Maintains and updates medical malpractice insurance coverage records in GENIUS (General Insurance Underwriting System).

Prepares correspondence and reports.

Testifies at administrative hearings.

Assists with updating assessment manuals in response to changes in legislation or policy.

Performs related work as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES:

Knowledge of liability coverage principles and practices applicable to medical malpractice insurance.

Ability to analyze medical malpractice insurance filings and related forms.

Ability to interpret and comprehend medical malpractice coverage principles and practices.

Ability to make arithmetical calculations.

Ability to establish and maintain effective working relationships.

Ability to orally communicate in a clear and concise manner.

Ability to communicate effectively in writing.

MINIMUM EXPERIENCE AND TRAINING:

Three years of experience in reviewing and examining medical malpractice insurance filings, forms, or policies, and two years of college or business school;

or

An equivalent combination of experience and training, which included at least one year of experience in reviewing and examining medical malpractice insurance filings, forms or policies.