Claims Examiner - Commercial GL

About the role

As the Healthcare Claims Examiner, you will directly handle Commercial Healthcare Claims across the U.S.

Key Accountabilities

• Ensure compliance with established claim handling guidelines regarding coverage, investigation, liability, damages, evaluation, and resolution
• Provide oversight on claims portfolios within the primary casualty book
• Maintain direct contact with insureds, agents, and brokers
• Provide oversight on claims portfolios handled by TPAs within the excess casualty book
• Engage in rigorous ALAE control and management by competently selecting, instructing, and managing 3rd party vendors
• Gather and analyse information necessary to make an accurate evaluation of the claim; deliver effective resolution, make decisions within established authority levels, and identify settlement issues
• Establish reserves pursuant to established reserving protocols and reserve authority procedures
• Successfully and proactively resolve complex and/or high exposure claims, promptly limiting exposure to the Company
• Participate substantially in mediation negotiations
• Adhere to the Panel Counsel Program and all Litigation Management Guidelines
• Meet all Reporting Requirements by completing reports timely and accurately, including Large Loss Reports
• Liaise and attend meetings with the underwriting team regarding claim trends and other areas of interest
• Work with external customers to address questions, resolve problems and maintain rapport
• Undertake general office administrative duties as required
• Proactively expand and maintain awareness of the current market/industry and attend continuing education programs when available

Technical Knowledge

• General understanding and knowledge of state and federal laws as they apply to US Specialty Healthcare claims
• General understanding of policy language/coverages applicable to US Specialty Healthcare
• Understanding of medical terminology

Experience

• College degree required or equivalent experience
• Must be licensed as a claims adjuster in home state; multi-state licensure preferred
• Minimum of 3 years of claims adjusting or legal experience required
• Background in US Healthcare Professional/General Liability preferred
• Prior experience as a Healthcare professional or Medical Malpractice attorney is a plus
• Experience handling Primary and Excess claims required
• Experience handling Reinsurance preferred

Skills

• Ability to travel for meetings, mediations and trials as required
• Ability to negotiate and be persuasive
• Strong communication and writing skills
• Detail oriented and organized
• Ability to work independently and as a team member
• Self-starter with problem solving skills
• Ability to manage pending caseloads, additional projects and meet all deadlines as set by management

Compensation & Benefits

Competitive salary. Medical, dental, vision, and life insurances; short and long-term disability; Company-match of 100% of a 6% contribution 401(k) plan; Employee Assistance Plan; Health Savings Account, Flexible Spending Account, Health Reimbursement Account; and a wellness program.

Professional Development

Opportunities for professional development and advancement.