Senior Claim Specialist - Physician Claims

Gallagher•Houston, TX

8h•$165,000•Remote

About The Position

The Senior Claims Specialist within GB Specialty is responsible for managing moderately complex Healthcare Professional Liability claims, with a primary focus on Physician Medical Malpractice exposures. This role manages the full claim life cycle, including coverage analysis, investigation, evaluation, and resolution, while ensuring claims are handled in accordance with client expectations, policy obligations, and regulatory requirements.

Requirements

Bachelor's Degree and 5+ years related claims experience required.
Prior experience working within the applicable specialty claims area or demonstrated ability to handle unique/challenging claims issues.
Appropriately licensed and/or certified in all states in which claims are being handled or able to obtain the licenses/certification per local requirements.
Knowledge of accepted industry standards and practices.
Computer experience with related claims and business software.
Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges.
Analytical skill necessary to make decisions and resolve issues inherent in handling of claims.
Ability to successfully negotiate the settlement and disposition of claims including the ability to interpret related documentation.

Nice To Haves

JD Highly Preferred
Licensed Attorney highly preferred.
2+ years of prior experience adjusting claims in Healthcare professional Liability

Responsibilities

Analyzes coverage and settles moderately complex claims in Healthcare Professional Liability focusing on Physician Claims (Medical Malpractice).
Generally, incumbent does not work on workers’ compensation claims.
Able to manage the full-life cycle of all assigned claims files.
Analyzes coverage and determines defense obligations.
Under minimal supervision, conducts thorough analysis and investigations necessary to determine claims exposure and recommend appropriate settlement strategies and action plans.
Creates reservation of rights and coverage denial letters.
Negotiates settlements with clients, client attorneys, and Public Adjusters.
Interacts extensively with various parties involved in the claims process, and may recommend retaining the advice of outside experts as necessary.
Prepares reserve and settlement authority requests for client and carrier approval.
May act as a client advocate with carriers to ensure proper claims handling, including any necessary scoping, estimating, and addressing of coverage.
Has a solid understanding of claims processing and the insurance brokerage business.
Has a basic understanding of the terminology and case law associated with correctional medicine professional liability claims.
Handles claims consistent with clients’ and corporate policies, procedures and best practices and in accordance with statutory, regulatory, and ethical requirements.
Incumbents at this level should be able to work at full caseload capacity.