Senior Claims Examiner, Healthcare
Arch Insurance Group Inc.•Jersey City, NJ
•$123,400 - $191,628•Hybrid
About The Position
The Claims Division is seeking a highly experienced professional to join the Healthcare Claims Team as a Senior Claims Examiner. In this role, the examiner will be responsible for actively managing and effectively overseeing an assigned caseload of complex healthcare-related claims for hospitals, miscellaneous healthcare facilities and other healthcare providers.
Requirements
- Bachelor’s degree required
- 3-7 years of work experience handling management liability claims process at a carrier, broker, or law firm
- Exceptional communication (written and verbal), evaluation, influencing, negotiating, listening, and interpersonal skills to effectively develop productive working relationships with internal/external peers and other professionals across organizational lines
- Strong time management and organizational skills
- Ability to take part in active strategic discussions
- Ability to work well independently and in a team environment
- Hands-on experience and strong aptitude with Microsoft Excel, PowerPoint and Word
- Willing and able to travel 15-20%
Nice To Haves
- Juris Doctorate degree preferred
- Proper adjuster licensing in all applicable states preferred
Responsibilities
- Identify and assess coverage issues, draft coverage position letters, and retain coverage counsel, when necessary as well as review coverage counsel's opinion letters and analysis
- Develop and implement strategy relative to coverage issues which correlate with the overall strategy of matters entrusted to the handler's care
- Develop and implement strategy to resolve matters of liability and damages of a particular case
- Maintain contact with the claim staff, business line leaders, underwriters, defense counsel, and brokers
- Investigate claim and review the insureds' materials, pleadings, and other relevant documents
- Identify and review of each jurisdiction's applicable statutes, rules, and case law
- Review litigation materials including depositions and expert's reports
- Analyze and direct risk transfer, additional insured issues, and contractual indemnity issues
- Retain counsel when necessary and direct counsel in accordance with resolution strategy
- Analyze coverage, liability and damages for purposes of assessing and recommending reserves
- Prepare and present written/oral reports to senior management setting forth all issues influencing evaluation and recommending reserves
- Travel to and from locations within the United States to attend mediations, trials, and other proceedings relevant to the resolution of the matter
- Negotiate resolution of claims
- Review and evaluate defense counsel invoices for reasonableness and process associated payments
- Maintain a diary of all claims, post reserves in a timely fashion, and expeditiously respond to claims inquiries from insured, counsel, underwriters, brokers, and senior management
Benefits
- Multiple medical plans plus dental, vision and prescription drug coverage
- A competitive 401k with generous matching
- PTO beginning at 20 days per year
- Up to 12 paid company holidays per year
- 2 paid days of Volunteer Time Offer
- Basic Life and AD&D Insurance as well as Short and Long-Term Disability
- Paid Parental Leave of up to 10 weeks
- Student Loan Assistance and Tuition Reimbursement
- Backup Child and Elder Care
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What This Job Offers
Job Type
Full-time
Career Level
Senior
