Claims Specialist - Executive Claims Specialist - Commercial Allied Health Claims

James River Holdings•Richmond, VA

29d

About The Position

Under minimal supervision, the Claims Specialist/Executive Claims Specialist manages a caseload of high complexity commercial insurance claims focused on Allied Health (assisted living and skilled nursing facilities). The Claims Specialist will review claims to analyze land determine applicable coverage, facts, liability, damages, plan and strategy for resolution in accordance with state and company guidelines. The Claims Specialist will function independently and act as a key resource on issues within area of specialty.

Requirements

High school diploma required
Bachelor's Degree preferred
Advanced Degree or Juris Doctorate Degree preferred
Minimum of seven years of experience handling primary and excess claims-made and occurrence liability policies and claims.
Experienced in coverage, liability, and litigated claims related to health services claims, assisted living and skilled care facilities claims, life sciences (medical devices and products) claims, and professional liability claims.
Successful candidate will have strong written, verbal, injury evaluation, and negotiation skills
Extensive expertise in specific specialty area of claims (i.e. PL, M&C, GL)
Expert level of expertise in claim handling and suit management
Expert knowledge of P&C insurance industry
Expert ability to effectively assess risk
Proficiency in MS Office (Word, Excel, Outlook)
Excellent written and verbal communication skills
Advanced analytical and organizational skills
Advanced negotiation skills
Ability to work independently and take initiative
Ability to exercise sound judgement in making critical decisions
Research, analysis and problem-solving skills
Ability to work in a team environment and accept feedback from Claims management
Ability to build effective relationships with business partners
Ability to organize complex information and pay close attention to detail
Ability to anticipate customer needs and take initiative to meet those needs
Ability to train and provide technical guidance to less experienced Claims professionals
Ability to successfully obtain the required state adjusters' licenses within six (6) months following the completion of Company-provided licensure training courses and maintain appropriate licensure thereafter

Nice To Haves

Adjuster license and/or certifications desired preferred
Project management and process implementation experience preferred

Responsibilities

Continuously exhibit and uphold Core Values of Integrity, Accountability, Communication and Teamwork, Innovation and Customer Service
Perform coverage, liability, and damage analysis on all claims assignments
Investigate allegations, determine facts based on evidence and interviews
Draft disclaimers and reservation of rights letters when coverage issues arise
Assign limited investigations and appraisals to independent licensed professionals
Manage a caseload of high complexity claims with delegated authority
Manage litigated files
Negotiate settlements, mitigate losses, and control expenses
Participate in and attend mediations to facilitate settlements
Maintain accurate documentation in claim files
Maintain a high level of communication internally with Claims management team and externally with insureds, claimants, attorneys and brokers
Act as a consultant providing technical expertise within specialty area to internal stakeholders
Provide technical guidance, assistance and training as needed for less experienced Claims professionals
Maintain a passing quality assurance score on all audits and QAs
Provide exceptional customer service to insureds, claimants, and attorneys, addressing inquiries, concerns, and providing regular updates on claim status
Ensure compliance with state regulations, industry standards, and best practices in claims handling, maintaining a high level of professionalism and integrity
Handle claims in accordance with established James River Claims Best Practices
Other duties as required by management