Complex Claims Specialist

Hiscox•Boston, NY

3d•Hybrid

About The Position

The Complex Claims Specialist – Allied Healthcare is an individual-contributor role responsible for handling mid- to high-severity primary Allied Healthcare Professional Liability claims from inception through resolution. The claims may involve mental health counseling practices, social services, medical spas, home health aide and healthcare staffing agencies, pharmacies, and testing laboratories. The role covers all aspects of claims and litigation, including coordination with internal and external business partners such as outside experts, legal counsel, and underwriting. The specialist handles claims with minimal supervision, applies advanced coverage and litigation knowledge, guides defense strategy, and seeks fair and timely outcomes for insureds and broker partners. The role also supports team development through mentoring and identifies emerging exposures, claims trends, and suspected fraud. The US Claims team is a growing group focused on customer service, claims expertise, profitability, and maintaining Hiscox’s reputation for outstanding claims handling. Claims staff manage files within their assigned authority.

Requirements

At least 6 years of Professional Liability and/or Medical Malpractice claims-handling experience.
Bachelor of Arts or Bachelor of Science degree required.
Proven ability to positively affect complex claim outcomes through investigation, negotiation, and effective leadership of litigation.
Ability to work in a fast-paced and changing environment.
Advanced knowledge of coverage within the team’s specialty or focus.
Advanced knowledge of litigation processes and negotiation skills.
Experience mentoring and training other claims examiners.
Excellent verbal and written communication skills.
Advanced analytical skills.
Adjuster licensing required within 90 days of employment.

Nice To Haves

Juris Doctor degree is optimal; a JD from an ABA-accredited law school may be considered as a supplement to claims-handling experience.
Ability to work with minimal oversight.
Ability to advance product innovation or develop broader business knowledge through training or relevant cross-team or cross-line-of-business projects.
Courage and confidence in addressing and resolving difficult or severe matters with insureds, attorneys, and brokers.
Experience attending and leading mediations, arbitrations, and trials.

Responsibilities

Adjust and resolve complex mid- to high-severity claims, including all phases of litigation.
Draft complex coverage letters, including reservation-of-rights and denial letters, with minimal supervision.
Review and analyze claim documentation and legal filings.
Lead defense strategy on litigated files and promote litigation best practices.
Mentor team members.
Investigate, negotiate, and use alternative dispute resolution to achieve positive claim outcomes.
Identify emerging exposures and claims trends.
Identify suspected fraudulent claims and coordinate tracking with the special investigations unit.
Document claim files accurately with relevant documentation, correspondence, and notes in compliance with company policies and applicable regulatory requirements.
Liaise with internal and external business partners, including outside experts, legal counsel, and underwriting, as required.

Benefits

Competitive salary and bonus based on personal and company performance.
401(k) with competitive company matching.
Comprehensive health insurance, vision, dental, and flexible spending account plans, including medical, limited-purpose, and dependent-care options.
Company-paid group term life insurance and short- and long-term disability coverage.
24 paid time off days, 2 Hiscox Days, and 10 paid holidays; option to purchase 5 additional PTO days.
Paid parental leave.
Four-week paid sabbatical after every 5 years of service.
Financial Adoption Assistance and Medical Travel Reimbursement Programs.
Annual reimbursement up to $600 for a health club membership or fees associated with a fitness program.
Dynamic, creative, and values-driven culture.
Modern, open office spaces and complimentary drinks.