Medical Manager
Resume:
JAMES C. O’HARE, RPLU, AIC, AIS
Davie, Florida 33330
Phone – 954-***-**** / E-mail: *******@***.***
Linkedin:
www.linkedin.com/pub/james-c-o-hare-rplu-aic-ais/1b/912/b9
OBJECTIVE
To become the leading team member in the Professional Liability Claims Insurance Industry using proven methods of analyzing claims and influencing favorable solutions.
EXPERTISE
Professional Liability Claims Specialist with over 26 years of proven results and valuable experience in influencing the financial impact of medical negligence claims; expertise includes: management of negotiations, risk analysis, operations, adjuster training, mentoring, medical record review. Candidate is educated, trained in medicine and law, and understands civil practice and standards of care for medical treatment in all disciplines. Professional liability claims experience in all disciplines in 34 states.
WORK EXPERIENCE
Grossman Roth P.A Sept 2012- April 2013
Coral Gables, Florida
Medical investigator/ Litigation manager – Professional liability analyst. Medical record review and analysis of liability, causation, and damages for potential claims. Accept and decline representation of new client's. Prepare initial memo's for potential new inquirie's. Preparation and explanation of contract's and authorization's to new clients. Selection and retention of appropriate medical experts. Interview expert's regarding standard's of care. Prepare affidavit's and Notice's of Intent to initiate litigation. Attend unsworn statement's as required. Prepare and discuss file strategy.
Medicus Insurance Company March-September 2011
Austin, Texas
Director of Claims – Responsibilities included: directing all professional liability claims-related activities for physicians in 31 states; developing plans for creating an in-house claims department. Created policy for reserving claims adjustment protocols which resulted in a top-level list for company’s defense panel, coverage analysis, policy review, billing guidelines and supervision of TPA adjusters. Attended mediations on high-value cases with successful outcomes.
Physicians Insurance Company September 2007 to March 2011
Pompano Beach, Florida
Vice President of Claims – As Medical Malpractice Claims Director for 950 Florida Physicians, successfully managed work flow with an emphasis on efficiency of procedures affecting loss adjustment expenses and indemnity. Proponent of best claims practices to influence the combined ratio; monitored reinsurance, case reserves, vendor billing, coverage analysis, case strategy as well as state and federal reporting. Maintained relationships and created good will with the plaintiff’s bar and competitors. Created an expert library to catalog physician resumes and deposition transcripts. Elevated accountability and developed relationships with vendors.
Offering preferred panel status in exchange for better rates resulted in a $1.00 per page savings per transcript and reduced the panel vendor list. Also negotiated flat rate fee for defense counsel through discovery; created arbitration agreement system for insureds; created an insureds’ database used for a monthly medical malpractice update and current trend reporting. Successfully earned the lowest claims loss ratio among professional liability carriers in Florida.
Claims and Risk Management Services February 2003 to August 2007
Miami, Florida
Professional Liability Claims Consultant – Evaluation, investigation and disposition of complex medical negligence claims; obtained experts and supporting affidavits; attended mediations and arbitrations to negotiate resolutions; applied expense and loss reserves for The Baptist Hospital Group and Mount Sinai Medical Center.
Cambridge Integrated Services June 2002 to February 2003
Hollywood, Florida
Claims Supervisor – Maintained case diary, investigated nursing home claims pursuant to Florida Statute Chapter 400; recommended reserves and settlement values; attended mediations and negotiated settlements.
Frontier Insurance Company July 1996 to March 2002
Mineola, New York
Litigation Claims Manager / Technical Director – Developed defense, cost savings strategies and litigation plans for over 1,400 medical, dental and social services claims; liaison to excess and reinsurance carriers; audited files for company standards. Created and implemented office policy; set loss and expense reserves; resolved coverage issues; analyzed loss runs; successfully negotiated high profile cases; interactive dispute resolution with plaintiff counsel, co-defendants and the judiciary. Successfully reviewed and approved settlement negotiations. Interviewed applicants; assigned counsel and necessary staffing.
Zurich Insurance February to June 1996
New York, New York
Claims Supervisor – National Accounts – Supervised medical and general liability accounts for hospitals, nursing homes and primary care physicians. Set reserves, service accounts, coverage interpretation and analysis and record review; sales and marketing of insurance products to new clients. Attended mediation and arbitration hearings.
Donald J. Fager & Associates April 1985 to February 1996
Medical Liability Mutual Insurance Company
New York, New York
Technical Claims Director – Special Claims Unit – As a representative of Medical Liabilty Mutual Insurance Company, licensed casualty adjuster and settlement specialist, performed successful negotiations of over 600 claims, lawsuits and verdicts using structured annuities and special needs trusts. Evaluated files presented for settlement authority, analyzed liability, causation and damages; had direct contact with the plaintiff bar and judiciary to negotiate settlements. As Claims Examiner had daily management of 400 claims, events and lawsuits. Reviewed records, directed field representatives and defense counsel; set expense and loss reserves; monitored trials, negotiated settlements, reviewed and authorized payment of legal expenses and analyzed coverage.
EDUCATION
Bachelor of Science University of the State of New York, Albany 1981
Litigation Paralegal Adelphi University, Garden City, New York 1981
PROFESSIONAL DESIGNATIONS
RPLU Registered Professional Liability Underwriter. PLUS
AIC Associate in Claims. AICPCU II
AIS Associate in Insurance Services. AICPCU II
Karrass Effective Negotiating Certification
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