Claims Examiner Jobs

About The Position

Requirements

• 1-3 years of claims handling experience with an insurance carrier, third-party administrator, law firm, healthcare organization, or related industry experience preferred.
• Experience handling Professional Liability, Allied Healthcare, Medical Malpractice, Long-Term Care, or Bodily Injury claims is a plus.
• Basic understanding of claims investigation, evaluation, and coverage analysis, with the ability to gather facts, review documentation, and identify key issues impacting claim resolution.
• Developing knowledge of reserve practices, including the ability to establish and adjust reserves with guidance based on liability, damages, and emerging claim information.
• Familiarity with claims-handling regulations, statutes of limitation, and jurisdictional considerations, or the ability to quickly learn and apply regulatory requirements.
• Ability to manage a caseload of low to moderate complexity claims while maintaining accurate documentation, diary management, and timely communication with insureds, brokers, counsel, and business partners.
• Demonstrated problem-solving and analytical skills, with the ability to identify potentially complex, sensitive, or high-exposure matters and escalate appropriately.
• Exposure to litigated claims or legal processes preferred, with an interest in developing skills related to litigation management, defense counsel oversight, and dispute resolution.
• Ability to review and analyze medical records, legal documents, and claim-related information to support claim evaluation and decision-making.
• Strong negotiation, communication, and customer service skills, with the ability to build effective relationships with insureds, brokers, healthcare providers, attorneys, and internal stakeholders.
• Proficiency with Microsoft Office applications and the ability to learn claims management systems.
• Active adjuster's license preferred but not required; ability to obtain required licensing within 90 days of employment.
• Bachelor's degree from an accredited college or university required; coursework or experience in insurance, healthcare, legal studies, risk management, or a related field is preferred.
• Strong organizational and time-management skills.
• Attention to detail and sound judgement.
• Customer-focused mindset.
• Effective written and verbal communication.
• Ability to learn quickly and adapt in a fast-paced environment.
• Collaborative approach to working with colleagues and business partners.

Nice To Haves

• Experience handling Professional Liability, Allied Healthcare, Medical Malpractice, Long-Term Care, or Bodily Injury claims.
• Exposure to litigated claims or legal processes.
• Interest in developing skills related to litigation management, defense counsel oversight, and dispute resolution.
• Active adjuster's license.
• Coursework or experience in insurance, healthcare, legal studies, risk management, or a related field.

Responsibilities

• Analyze professional liability exposures involving Allied Healthcare providers, facilities, and services.
• Interpret policy language, endorsements, exclusions, limits, retentions, and coverage triggers specific to Allied Healthcare risks.
• Develop and maintain claim action plans addressing coverage, liability, damages, litigation strategy, reserves, and resolution opportunities.
• Conduct timely investigations, including review of medical records, provider documentation, licensing information, contracts, and applicable standards of care.
• Evaluate complex causation and damages issues with defense counsel, medical experts, and other consultants.
• Manage litigation through trial, including counsel selection, budgets, legal strategy, expert retention, mediation, settlement conferences, and trial preparation.
• Identify matters requiring escalation based on severity, coverage complexity, reputational risk, regulatory exposure, or potential excess involvement.
• Present significant or high-exposure claims at roundtables and clearly document decisions and follow-up actions.
• Maintain accurate diaries, reserves, litigation plans, and reporting in accordance with internal Best Practices and regulatory requirements.
• Collaborate with underwriting, actuarial, risk management, brokers, and insureds to identify claim trends and risk-improvement opportunities.
• Deliver responsive, empathetic service to insured professionals and organizations during sensitive claim situations.

Benefits

• Competitive salary and bonus (based on personal & company performance)
• 401(k) with competitive company matching
• Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)
• Company paid group term life, short-term disability and long-term disability coverage
• 24 Paid time off days, 2 Hiscox Days, 10 paid holidays, and ability to purchase 5 PTO days
• Paid parental leave
• 4 week paid sabbatical after every 5 years of service
• Financial Adoption Assistance and Medical Travel Reimbursement Programs
• Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
• Company paid subscription to Headspace to support employees’ mental health and wellbeing
• Recipient of 2024 Cigna’s Well-Being Award for having a best-in-class health and wellness program
• Dynamic, creative and values-driven culture
• Modern and open office spaces, complimentary drinks