Senior Claims Examiner, Healthcare
About The Position
Berkshire Hathaway Specialty Insurance (BHSI) is seeking an experienced professional to join its growing Healthcare Claims team in Chicago, Atlanta, Boston, or New York. The role may suit an experienced healthcare claims professional or a practicing attorney transitioning from a law firm to the insurance industry. The Senior Claims Examiner handles and adjusts Senior Care and Healthcare claims involving primary, umbrella, and excess policies. The position manages claims from first notice through resolution, evaluates complex coverage, liability, and damages issues, and works with insureds, brokers, third-party administrators (TPAs), defense counsel, and internal partners. The role applies technical and legal judgment to support fair, timely, and effective claim outcomes while building trusted relationships.
Requirements
- 5–10+ years of Healthcare claims handling experience or equivalent relevant experience.
- College degree required.
- Strong technical knowledge and demonstrated capability in handling complex Healthcare claims.
- Experience evaluating coverage, liability, damages, reserves, and claim strategy across the lifecycle of a claim.
- Strong analytical and judgment skills, including the ability to independently assess complex information and reach well-supported conclusions.
- Excellent interpersonal, written and verbal communication, and negotiation skills.
- Ability to work independently and collaborate effectively with insureds, brokers, TPAs, counsel, and internal teammates.
- Strong organizational skills and ability to manage multiple complex matters and priorities simultaneously.
- Experience handling and adjusting claims across multiple jurisdictions.
- Must possess, or be willing and able to obtain, applicable claims licenses as required.
Nice To Haves
- Juris Doctor (JD).
Responsibilities
- Manage and adjust Healthcare and Senior Care claims involving primary, umbrella, and excess policies while delivering strong customer service and maintaining technical claim file quality.
- Proactively manage claims from first notice of loss through resolution, partnering with insureds, brokers, TPAs, and internal stakeholders.
- Analyze policy language and coverage issues, draft coverage correspondence as appropriate, and communicate coverage positions.
- Lead and coordinate claim investigations, evaluating coverage, liability, damages, and overall exposure to support timely claim decisions.
- Direct and monitor assignments to experts and defense counsel, providing strategic guidance and appropriate oversight.
- Develop claim strategies, set reserves within delegated authority, and recommend reserve changes based on evolving exposure.
- Prepare timely claim reports and maintain accurate documentation throughout the life of each claim.
- Represent BHSI at conferences, mediations, trials, and other claim-related proceedings as appropriate.
- Collaborate across the Claims organization and with business partners to support effective customer outcomes and BHSI standards.
Benefits
- Comprehensive health benefits
- Dental benefits
- Vision benefits
- Short-term and long-term disability insurance
- Life insurance
- Accidental Death & Dismemberment insurance
- Flexible Spending Accounts
- Health Reimbursement Account
- Employee Assistance Program
- 401(k) retirement savings plan with company match
- Generous holidays and paid time off
- Tuition reimbursement
- Paid parental leave
- Annual bonus eligibility
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What This Job Offers
Job Type
Full-time
Career Level
Senior
