Senior Complex Claims Specialist - Allied Healthcare

Hiscox•Boston, NY

2d•Hybrid

About The Position

The Senior Complex Claims Specialist – Allied Healthcare is an individual-contributor role handling primarily high-severity primary Allied Healthcare Professional Liability claims from inception through resolution. Covered practice areas include mental health counseling, social services, medical spas, home health aide and healthcare staffing agencies, pharmacies, and testing laboratories. The role manages all aspects of the claims and litigation process and works with internal and external partners, including experts, legal counsel, and underwriting. The specialist serves as a subject matter expert, models best practices for litigation and file integrity, and identifies emerging exposures, claims trends, and suspected fraud. With minimal supervision, the specialist adjusts the highest-severity claims, prepares complex coverage analyses and letters, and seeks positive outcomes through investigation, negotiation, alternative dispute resolution, and appropriate trial strategy. The US Claims team is a growing group focused on customer service, claims expertise, fair and timely resolutions for insureds and broker partners, and profitable growth while maintaining Hiscox’s reputation for claims handling. The position is hybrid and requires two days in the office each week.

Requirements

At least 10 years of Professional Liability and/or Medical Malpractice liability claims-handling experience.
Bachelor of Arts or Bachelor of Science degree required.
Adjuster licensing required within 90 days of employment.
Demonstrated ability to improve complex claims outcomes through investigation, negotiation, and effective litigation leadership.
Ability to work in a fast-paced, 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.
Demonstrated ability to manage defense counsel and claim strategy and improve outcomes on the highest-severity claims.

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 broaden understanding of other business areas through training or cross-team projects.
Courage and confidence in addressing and resolving 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 claims and litigation, coordinating with internal and external business partners, including outside experts, legal counsel, and underwriting.
Act as a subject matter expert within the team and model best practices for litigation and claim-file integrity.
Identify emerging exposures and claims trends and propose potential solutions.
Identify suspected fraudulent claims and coordinate tracking with the special investigations unit.
Adjust the highest-severity claims with minimal supervision.
Draft complex technical coverage analyses and coverage letters.
Use investigation, negotiation, and alternative dispute resolution to achieve positive claim outcomes, including identifying matters appropriate for trial.
Document claim files accurately with relevant correspondence and notes in compliance with requirements.
Lead litigation, manage defense counsel, and develop claim strategy for the highest-severity claims.
Mentor and train other claims examiners.

Benefits

Competitive salary and performance-based bonus.
401(k) with competitive company matching.
Comprehensive health insurance, vision and dental insurance, and flexible spending account plans for medical, limited-purpose, and dependent-care expenses.
Company-paid group term life insurance and short-term and long-term disability coverage.
24 paid time-off days, 2 Hiscox Days, and 10 paid holidays, with the ability to purchase 5 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 a 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.