Claims Examiner - Commercial Healthcare

Key Accountabilities/Deliverables

• 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 third-party vendors, as appropriate.
• Gather and analyze information necessary to make an accurate evaluation of the claim by delivering effective resolution of claims, 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.
• Substantially involved 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, etc.
• 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.
• Occasional domestic travel may be required to attend mediations and/or trials.
• Undertake general office administrative duties as and when required.
• Proactively expand and maintain awareness of the current market/industry and attend continuing education programs when available.

Technical Knowledge and Understanding

• Must possess a general understanding and knowledge of state and federal laws as they apply to US Specialty Healthcare claims.
• Must possess a general understanding of policy language/coverages applicable to US Specialty Healthcare.
• Must understand medical terminology.

Experience

• College degree required or equivalent experience.
• A minimum of 3 years of claims adjusting or legal experience is required.
• A background in US Healthcare Professional/General Liability is preferred.
• A prior history of employment as a Healthcare professional or Medical Malpractice attorney is a plus.
• Must have experience handling Primary and Excess claims.
• Additional experience handling Reinsurance is preferred.

Skills

• Ability to travel for meetings, mediations, and trials as required.
• Ability to negotiate and be persuasive.
• Possess strong communication and writing skills.
• Must be detail-oriented and organized.
• Must possess the ability to work independently and as a team member.
• Must be a self-starter and possess problem-solving skills.
• Must be able to manage pending caseloads, additional projects, and meet all deadlines as set by management.

Qualifications

• Must be authorized to work for any employer in the U.S.

Benefits

• Competitive salary.
• Professional development and advancement opportunities.
• Medical, dental, vision, and life insurance.
• Short and long-term disability insurance.
• A Company-matched 100% of a 6% contribution 401(k) plan.
• An Employee Assistance Plan.
• Health Savings Account, Flexible Spending Account, Health Reimbursement Account, and a wellness program.