Healthcare Lead Claims Specialist

Risk Strategies • New York, NY

7d • Hybrid

About The Position

To provide ultimate claim service for insurance claim matters presented by clients of Risk Strategies Inc., and affiliates, in accordance with objectives and procedures outlined by management. Your Impact Receive loss reports from Healthcare Clients and confirm that the claims are filed under the appropriate policy(ies) Research policy terms and stipulations to determine coverage applicability and advocate for maximum recovery. Strong understanding of all lines of insurance policies, coverage, and relevant regulations. Educate and address questions from Clients regarding claim reporting requirements Advocate for the client, maintaining an active diary, transmittal of documentation, follow up calls, and emails to the client and carrier Oversee the claims at the carriers to ensure timely investigation, liability determination, litigation and fair resolutions. Evaluate complex, high-exposure claims and interpret policy wording. Ability to work with demanding stakeholders, maintain client relationships, and be firm with carriers regarding policy coverage. Meet with clients when necessary and taking part in claim meetings, renewals and stewardship meetings Vital liaison between Client, insurance carrier, Defense Counsel and other vendors Partner and provide service to the internal Account Executive team and Producers re the service to the Client regarding claims, data analytics, providing education to the Client and cost containment initiatives. Perform Strategic Claim Reviews working in turn with Loss Control and Analytics Review claim trending and address any opportunities with the Client for Loss control initiatives. Counsel Clients on cost containment initiatives to reduce total claims, loss ratios, financials, timely file closure rates as well as timely reporting days.

Requirements

• Valid P&C Brokers’ license or adjuster license – Multi State
• Minimum of 7-10 years of experience as a specialist in dedicated industry
• Must possess advanced knowledge of Property & Casualty coverages to include Healthcare Medical Professional Liability, Professional and General Liability for Healthcare systems and Cyber Liability
• Familiarity with Claims Made and Occurrence policy forms with reporting protocols for Healthcare clients
• Extensive knowledge of multi-line coverage and how coverage applies in the Healthcare industry
• Demonstrate proficiency in computer applications, esp. Microsoft Office Suite
• Possess the ability to provide superior customer service to both external and internal clients
• Possess excellent client advocacy and negotiation skills
• Ability to perform strategic claim review
• Expertise in business practice area(s)
• Possess claim management/consultative skills

Responsibilities

• Receive loss reports from Healthcare Clients and confirm that the claims are filed under the appropriate policy(ies)
• Research policy terms and stipulations to determine coverage applicability and advocate for maximum recovery
• Educate and address questions from Clients regarding claim reporting requirements
• Advocate for the client, maintaining an active diary, transmittal of documentation, follow up calls, and emails to the client and carrier
• Oversee the claims at the carriers to ensure timely investigation, liability determination, litigation and fair resolutions
• Evaluate complex, high-exposure claims and interpret policy wording
• Meet with clients when necessary and taking part in claim meetings, renewals and stewardship meetings
• Partner and provide service to the internal Account Executive team and Producers re the service to the Client regarding claims, data analytics, providing education to the Client and cost containment initiatives
• Perform Strategic Claim Reviews working in turn with Loss Control and Analytics
• Review claim trending and address any opportunities with the Client for Loss control initiatives
• Counsel Clients on cost containment initiatives to reduce total claims, loss ratios, financials, timely file closure rates as well as timely reporting days

Benefits

• Comprehensive risk management advice, insurance and reinsurance placement for property & casualty, employee benefits, private client services, as well as consulting services and financial & wealth solutions.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed