Senior Complex Claims Specialist - Allied Healthcare

Hiscox•Boston, MA

3d•$140,000 - $170,000•Hybrid

About The Position

The Senior Complex Claims Specialist - Allied Healthcare is an individual-contributor role handling mostly high-severity primary Allied Healthcare Professional Liability claims from inception to resolution. The claims may involve mental health counseling practices, social services, medical spas, home health aid and healthcare staffing agencies, pharmacies, and testing laboratories. The role manages all aspects of claims and litigation and liaises with internal and external business partners, including outside experts, legal counsel, and underwriting, as required. The specialist serves as a subject matter expert within the team, models litigation best practices and file integrity, and identifies emerging exposures, claims trends, and suspected fraud. With minimal supervision, the role adjusts the highest-severity claims through resolution and prepares complex technical coverage analyses and letters. It uses investigation, negotiation, and alternative dispute resolution to pursue positive claim outcomes, identifies matters appropriate for trial, and maintains accurate claim documentation in compliance. The US Claims team works to provide strong customer service and claims-handling expertise. Staff manage claims within their authority to deliver fair and timely resolutions for insureds and broker partners, while supporting profitability and Hiscox’s claims-handling reputation. The position is hybrid and requires two days in the office each week.

Requirements

10 or more years of Professional Liability and/or Medical Malpractice liability handling experience.
Bachelor of Arts or Bachelor of Science degree required.
Adjuster licensing required within 90 days of employment.
Proven ability to positively affect complex claims outcomes through investigation, negotiation, and effective litigation leadership.
Ability to work in a fast-paced and changing environment.
Advanced knowledge of coverage within the team’s specialty or focus.
Advanced knowledge of the litigation process and negotiation skills.
Experience mentoring and training other claims examiners.
Excellent verbal and written communication skills.
Advanced analytical skills.
Proven ability to positively affect highest-severity claims outcomes through investigation, negotiation, effective litigation leadership, and management of defense counsel and claim strategy.

Nice To Haves

Juris Doctor degree is optimal; a JD from an ABA-accredited law school may be considered as a supplement to claims-handling experience.
Subject matter expertise or technical leadership in other lines of business and/or claim types.
Ability to work with minimal oversight.
Ability to advance product innovation or develop a broader understanding of other business areas through training or relevant cross-team or cross-line projects.
Courage and confidence in addressing and solving difficult or severe matters with insureds, attorneys, and brokers.

Responsibilities

Handle mostly high-severity primary Allied Healthcare Professional Liability claims from inception to resolution.
Manage all aspects of the claims and litigation process, coordinating with internal and external business partners as required.
Act as a subject matter expert within the team.
Model litigation best practices and maintain file integrity.
Identify emerging exposures and claims trends and provide potential solutions.
Identify suspected fraudulent claims and track them with the special investigations unit.
Adjust the highest-severity claims to resolution with minimal supervision.
Draft complex technical coverage analyses and letters.
Use investigation, negotiation, and alternative dispute resolution to affect positive claim outcomes, and identify matters appropriate for trial.
Document claim files accurately with relevant correspondence and notes in compliance.
Mentor and train other claims examiners.
Lead litigation and manage defense counsel and claim strategy on complex, high-severity matters.

Benefits

Competitive salary and performance-based bonus.
401(k) with competitive company matching.
Comprehensive health insurance, vision, dental, and flexible spending account plans, including medical, limited-purpose, and dependent-care plans.
Company-paid group term life, short-term disability, and long-term disability coverage.
24 paid time off days, two Hiscox Days, and 10 paid holidays; option to purchase five additional PTO days.
Paid parental leave.
Four-week paid sabbatical after every five years of service.
Financial Adoption Assistance and Medical Travel Reimbursement Programs.
Annual reimbursement up to $600 for health club membership or fees associated with a fitness program.
Health and wellness program recognized with the 2024 Cigna Well-Being Award.
Modern open office spaces and complimentary drinks.