Senior Claims Specialist, HMO & PEI Claims

Liberty Mutual • Weatogue, CT

3d • Hybrid

About The Position

Working under moderate direction, this role manages a book of specialty lines claims across the full claim lifecycle — from initial investigation through settlement and closure. The Claims Specialist conducts thorough investigations, recommends appropriate reserves, and resolves claims efficiently and cost-effectively within established authority limits for the line of business.

Requirements

• Bachelor's degree required
• 5+ years of experience in claims handling, legal, or a related field
• Strong working knowledge of claims handling concepts, practices, and techniques, including coverage issues and product line expertise
• Solid understanding of insurance law and regulations across multiple jurisdictions
• Excellent verbal and written communication skills
• Strong negotiation skills, with the ability to resolve claims effectively within authority limits

Nice To Haves

• advanced degree preferred
• Experience handling HMO and Provider Excess Claims

Responsibilities

• Analyzes, investigates, and evaluates losses to determine coverage and appropriate claim disposition
• Documents claims and sets diaries for follow-up and key events using CMS
• Establishes appropriate indemnity and expense reserves within assigned settlement authority, reviewing regularly to ensure adequacy; recommends reserve levels for claims exceeding authority
• Prepares comprehensive claim reports as required
• Identifies emerging claim trends and account or policy issues, communicating findings to management and underwriting
• Manages the litigation process, including retaining counsel and overseeing case resolution
• Ensures adherence to line-of-business litigation guidelines, including budget management, bill review, and payment
• Actively participates in mediations and arbitrations within assigned settlement authority
• Participates in the claims audit process
• May support claims marketing efforts by engaging with brokers, risk managers, and reinsurers
• Maintains required insurance adjuster licenses

Benefits

• comprehensive benefits
• workplace flexibility
• professional development opportunities
• Employee Resource Groups

What This Job Offers

• Job Type: Full-time
• Career Level: Senior