Lead Claims Specialist, HPL

Tokio Marine HCC • Alpharetta, GA

1d • Hybrid

About The Position

The Lead Claims Specialist manages hospital professional liability, general liability, auto, and managed care claims for the Excess Healthcare line of business. The role involves investigating coverage, evaluating liability and damages, and resolving claims, including negotiating settlements. The specialist oversees claims to minimize company risk, communicates coverage decisions, directs external counsel and vendors, and supports timely, well-documented claim handling. The role also includes mentoring less experienced adjusters, representing TMHCC at industry conferences, conducting insured audits and loss-run reviews, and contributing to claims systems and process development. The position has planning, communication, cost-management, business-controls, and people-management responsibilities.

The role is based on a 4:1 hybrid schedule at the Alpharetta or Kennesaw office and reports to the Head of Excess & Healthcare Claims. Regular travel may be required, up to 50% of the time.

Requirements

• Bachelor’s degree in business administration, risk management, and/or insurance.
• State adjusting licenses.
• Six years of relevant and progressive experience handling medical professional liability claims throughout the United States.
• Effective and efficient work practices, with a focus on continuous improvement and innovation.
• Sound analytical skills and strong decision-making and problem-solving aptitude.
• Exceptional communication skills and ability to build internal and external connections.
• Flexibility and willingness to learn and adapt to developing processes, systems, and procedures.
• Excellent written and verbal communication skills, with an emphasis on confidentiality, tact, and diplomacy.
• Intermediate to advanced proficiency and experience with Microsoft Office, including Excel, Access, PowerPoint, and Word.

Responsibilities

• Proactively oversee all aspects of claims to minimize company risk of loss.
• Analyze and draft coverage letters and communicate coverage positions to insureds, brokers, and agents.
• Conduct proactive claim investigations and maintain a diary using best practices.
• Set timely reserves and draft concise reports to leadership when authority is exceeded.
• Assign, direct, and closely monitor outside counsel and vendors as needed.
• Negotiate claim settlements and attend court hearings, mediations, settlement conferences, and trials.
• Complete required regulatory reporting.
• Mentor and educate less experienced adjusters.
• Represent TMHCC at industry conferences as necessary to establish the company as a market thought leader.
• Conduct insured audits and loss-run reviews and produce reports for senior leadership.
• Assist in developing claims systems and processes.
• Develop work plans, timelines, and goals; assign resources as needed; and meet deadlines.
• Communicate team or work-unit results and recommendations to management and clients as appropriate.
• Improve business processes and assist with implementing new processes, ensuring work is thorough, cost-efficient, and productive.
• Comply with corporate policies and procedures, report control breakdowns to management, and ensure safe practices and compliance within the assigned work unit.
• Plan, conduct, and supervise assignments; train personnel and assign work; and possibly assist with personnel reviews and evaluations.

Benefits

• Competitive salary.
• Comprehensive medical, vision, and dental benefits, with eligibility beginning on the date of hire.
• Ongoing learning and development opportunities.
• Basic life and disability insurance.
• 401(k) plan with a 6% company match.
• 20 days of PTO, two floating holidays, approximately 11 paid holidays, and volunteer time off.
• Paid parental leave.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior