Senior Claims Examiner - Allied Healthcare

Hiscox•Scottsdale, NY

2d•Hybrid

About The Position

The Senior Claims Examiner-Allied Healthcare handles assigned claims within given authority and according to Hiscox Claims Best Practices. This position is primarily hybrid and requires in-office attendance at least two (2) days per week for candidates that are located near one of our office locations. However, qualified remote candidates will also be considered. The role involves analyzing professional liability exposures involving Allied Healthcare providers, facilities, and services, interpreting policy language, and developing claim action plans. The examiner will conduct investigations, evaluate complex causation and damages, and manage litigation through trial. They will also identify matters requiring escalation, present significant claims, and maintain accurate documentation and reserves. Collaboration with various departments and delivering responsive, empathetic service to insureds are key aspects of the role.

Requirements

1-3 years of claims handling experience with an insurance carrier, third-party administrator, law firm, healthcare organization, or related industry experience preferred.
Experience handling Professional Liability, Allied Healthcare, Medical Malpractice, Long-Term Care, or Bodily Injury claims is a plus.
Basic understanding of claims investigation, evaluation, and coverage analysis, with the ability to gather facts, review documentation, and identify key issues impacting claim resolution.
Developing knowledge of reserve practices, including the ability to establish and adjust reserves with guidance based on liability, damages, and emerging claim information.
Familiarity with claims-handling regulations, statutes of limitation, and jurisdictional considerations, or the ability to quickly learn and apply regulatory requirements.
Ability to manage a caseload of low to moderate complexity claims while maintaining accurate documentation, diary management, and timely communication with insureds, brokers, counsel, and business partners.
Demonstrated problem-solving and analytical skills, with the ability to identify potentially complex, sensitive, or high-exposure matters and escalate appropriately.
Exposure to litigated claims or legal processes preferred, with an interest in developing skills related to litigation management, defense counsel oversight, and dispute resolution.
Ability to review and analyze medical records, legal documents, and claim-related information to support claim evaluation and decision-making.
Strong negotiation, communication, and customer service skills, with the ability to build effective relationships with insureds, brokers, healthcare providers, attorneys, and internal stakeholders.
Proficiency with Microsoft Office applications and the ability to learn claims management systems.
Active adjuster's license preferred but not required; ability to obtain required licensing within 90 days of employment.
Bachelor's degree from an accredited college or university required; coursework or experience in insurance, healthcare, legal studies, risk management, or a related field is preferred.
Strong organizational and time-management skills.
Attention to detail and sound judgement.
Customer-focused mindset.
Effective written and verbal communication.
Ability to learn quickly and adapt in a fast-paced environment.
Collaborative approach to working with colleagues and business partners.

Nice To Haves

Experience handling Professional Liability, Allied Healthcare, Medical Malpractice, Long-Term Care, or Bodily Injury claims.
Exposure to litigated claims or legal processes.
Active adjuster's license.
Coursework or experience in insurance, healthcare, legal studies, risk management, or a related field.

Responsibilities

Analyze professional liability exposures involving Allied Healthcare providers, facilities, and services.
Interpret policy language, endorsements, exclusions, limits, retentions, and coverage triggers specific to Allied Healthcare risks.
Develop and maintain claim action plans addressing coverage, liability, damages, litigation strategy, reserves, and resolution opportunities.
Conduct timely investigations, including review of medical records, provider documentation, licensing information, contracts, and applicable standards of care.
Evaluate complex causation and damages issues with defense counsel, medical experts, and other consultants.
Manage litigation through trial, including counsel selection, budgets, legal strategy, expert retention, mediation, settlement conferences, and trial preparation.
Identify matters requiring escalation based on severity, coverage complexity, reputational risk, regulatory exposure, or potential excess involvement.
Present significant or high-exposure claims at roundtables and clearly document decisions and follow-up actions.
Maintain accurate diaries, reserves, litigation plans, and reporting in accordance with internal Best Practices and regulatory requirements.
Collaborate with underwriting, actuarial, risk management, brokers, and insureds to identify claim trends and risk-improvement opportunities.
Deliver responsive, empathetic service to insured professionals and organizations during sensitive claim situations.

Benefits

Competitive salary and bonus (based on personal & company performance)
401(k) with competitive company matching
Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)
Company paid group term life, short-term disability and long-term disability coverage
24 Paid time off days
2 Hiscox Days
10 paid holidays
Ability to purchase 5 PTO days
Paid parental leave
4 week paid sabbatical after every 5 years of service
Financial Adoption Assistance and Medical Travel Reimbursement Programs
Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
Company paid subscription to Headspace to support employees’ mental health and wellbeing