Senior Claims Specialist - Healthcare Professional Liability - Long Term Care

Gallagher•Houston, TX

5h•Remote

About The Position

The Senior Claims Specialist within GB Specialty manages moderately complex Healthcare Professional Liability – Long Term Care claims. The role oversees the full claim lifecycle, including coverage analysis, investigation, evaluation, and resolution, ensuring claims are handled in accordance with client expectations, policy obligations, and regulatory requirements. The position is fully remote and is open to candidates in any jurisdiction. The incumbent must be willing to obtain any licenses required by the manager within a specified timeframe and should be able to handle a full caseload with minimal supervision.

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 in accordance with local requirements.
Knowledge of accepted industry standards and practices.
Computer experience with related claims and business software.
Ability to think critically, solve problems, and plan and organize activities.
Ability to 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, including interpreting 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 – Long Term Care or Medical Malpractice claims.

Responsibilities

Analyze coverage and settle moderately complex Healthcare Professional Liability claims.
Manage the full lifecycle of assigned claims files.
Analyze coverage and determine defense obligations.
Conduct thorough claim analysis and investigations to assess 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 appropriate.
Prepare reserve and settlement authority requests for client and carrier approval.
Act as a client advocate with carriers when appropriate, including addressing claims handling, scoping, estimating, and coverage.
Handle claims consistently with client and corporate policies, procedures, best practices, and statutory, regulatory, and ethical requirements.
Manage a full caseload capacity.