Senior Claims Specialist - Healthcare Professional Liability - Medical Malpractice

Gallagher•Houston, TX

12h•Remote

About The Position

The Senior Claims Specialist within GB Specialty manages moderately complex Healthcare Professional Liability - Medical Malpractice claims. The role oversees 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. This role is eligible for fully remote work and is open to any jurisdiction. The incumbent must be willing to obtain required licenses within a timeframe specified by the manager. The role works under minimal supervision and should be able to manage a full caseload. It generally does not involve workers’ compensation claims. The position requires a solid understanding of claims processing and the insurance brokerage business, along with a basic understanding of terminology and case law associated with medical professional liability claims.

Requirements

Bachelor's degree.
At least 5 years of related claims experience.
Prior experience in the applicable specialty claims area or demonstrated ability to handle unique or challenging claims issues.
Appropriate licenses and/or certifications in all states where claims are handled, or ability to obtain them according to 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, communicate effectively verbally and in writing, and embrace new challenges.
Analytical skills to make decisions and resolve issues involved in claims handling.
Ability to negotiate claim settlements and dispositions and interpret related documentation.

Nice To Haves

Juris Doctor (JD); highly preferred.
Licensed attorney; highly preferred.
At least 2 years of prior experience adjusting Healthcare Professional Liability - Medical Malpractice claims.

Responsibilities

Analyze coverage and settle moderately complex Healthcare Professional Liability claims.
Manage the full life cycle of assigned claims files.
Analyze coverage and determine defense obligations.
Conduct thorough analysis and investigations to determine claims exposure and recommend settlement strategies and action plans.
Create reservation of rights and coverage denial letters.
Negotiate settlements with clients, client attorneys, and Public Adjusters.
Interact with parties involved in the claims process and recommend retaining outside experts when necessary.
Prepare reserve and settlement authority requests for client and carrier approval.
Act as a client advocate with carriers to support proper claims handling, including scoping, estimating, and addressing coverage as necessary.
Handle claims consistently with client and corporate policies, procedures, and best practices, and with statutory, regulatory, and ethical requirements.
Work at full caseload capacity.