Complex Claims Specialist
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 to resolution. Claim areas include mental health counseling practices, social services, medical spas, home health aid and healthcare staffing agencies, pharmacies, and testing laboratories. The role covers all aspects of the claims and litigation process and involves liaising with internal and external business partners, including outside experts, legal counsel, and underwriting. The specialist manages claims within assigned authority and works to deliver fair and timely resolutions for insureds and broker partners.
Requirements
- At least 6 years of Professional Liability and/or Medical Malpractice claims-handling experience.
- Bachelor of Arts or Bachelor of Science degree required; a JD is optimal.
- A JD from an ABA-accredited law school may be considered as a supplement to claims-handling experience.
- Proven ability to positively affect complex claims outcomes through investigation, negotiation, and effective litigation leadership.
- Ability to work in a fast-paced and changing environment.
- Advanced knowledge of coverage within the team’s specialty or focus.
- Advanced knowledge of the litigation process 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
- Experience attending and leading mediations, arbitrations, and trials.
- Ability to advance product innovation or develop a greater understanding of other business areas through training or relevant cross-team projects.
- Ability to work with minimal oversight.
- Confidence and courage in addressing and resolving difficult or complex matters with insureds, attorneys, and brokers.
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.
- Drive litigation best practices and lead defense strategy on litigated files.
- Mentor team members.
- Use investigation, negotiation, and alternative dispute resolution to achieve positive claim outcomes.
- Identify emerging exposures and claims trends.
- Identify suspected fraudulent claims and track them with the special investigations unit.
- Accurately document claim files, including relevant documentation, correspondence, and notes, in compliance with company policies and applicable regulatory authorities.
- Liaise with internal and external business partners, such as outside experts, legal counsel, and underwriting.
Benefits
- Competitive salary and performance-based bonus.
- 401(k) with competitive company matching.
- Health insurance, vision insurance, dental insurance, and flexible spending account plans, including medical, limited-purpose, and dependent-care plans.
- Company-paid group term life, short-term disability, and long-term disability coverage.
- 24 paid time-off days, 2 Hiscox Days, 10 paid holidays, and the ability to purchase 5 additional PTO days.
- Paid parental leave.
- Four-week paid sabbatical after every five 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.
- Health and wellness program.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
