Complex Loss Specialist (Allied Health)

About the role

Integrated Specialty Coverages, LLC (ISC) is a growth stage technology and data-driven commercial MGA and insurance wholesaler leading innovation in the market. Backed by one of the leading private equity firms, Onex Partners, and led by a forward-thinking management team, ISC is combining the worlds of insurance and technology to create an Insurtech powerhouse. As a leading online distributor of insurance products for a range of industries and "Main Street USA", we are looking for the right people to help us in our mission of achieving exponential growth. We strive to be the number one place to go for brokers and agents to source insurance. To accomplish this, we’re building a digitally focused team that deeply understands the intersection between user experience, data, and AI/ML to optimize the way we engage with our customers and partners.

Responsibilities

• Contribute to a collaborative environment by consistently demonstrating teamwork, high motivation, positive behavior, and effort to achieve goals and objectives.
• Build and maintain productive relationships with internal and external customers, including clients, underwriting and service teams, and agents.
• Research applicable coverage for our insureds. Document coverage dates, limits, and restrictions.
• Identify and resolve any potential coverage questions. Draft reservation of rights and coverage denials for review and approval by their Supervisor/Manager.
• Investigate facts of the loss by securing statements and supporting documentation such as contracts, cost of repair estimates, expert reports, photos, correspondence, etc.
• Document activities in writing within claim files.
• Exercise judgment in applying legal liability to assigned claims and will have settlement authority up to their specific authority, which may vary from carrier to carrier.
• Assign defense counsel to answer and defend lawsuits where appropriate. Monitor and direct defense counsel, independent adjusters, and experts.
• Identify claims with potential exposure in excess of authority and advise their Supervisor/Manager.
• Evaluate, set, or recommend reserves for each file they are handling.
• Prepare written reports as dictated by company policy and procedures.
• Handle claims within guidelines of the Fair Claims Practices 790.03.
• Provide insureds, claimants, underwriters, and carriers with regular updates on status of file handling.
• Discuss unique and complex files with Supervisor/Manager.
• Core Technical Duties:
  • Healthcare liability claims investigation and evaluation, including medical malpractice, general liability, and professional liability exposures.
  • Coverage analysis and interpretation of allied health professional liability policies, including review of coverage dates, limits, exclusions, and endorsements.
  • Medical record review and interpretation across allied health disciplines (physical therapy, home health, diagnostics, behavioral health, etc.).
  • Drafting reservation of rights letters and coverage denial communications for supervisor review.
  • Reserve evaluation, setting, and recommendation based on exposure analysis and claim trajectory.
  • Litigation management, including assignment and direction of defense counsel, independent medical examiners, and expert witnesses.
  • Investigation & Documentation:
    • Securing recorded and written statements from insureds, claimants, and witnesses.
    • Gathering and organizing supporting documentation including incident reports, medical records, licensing records, contracts, and expert reports.
    • Maintaining accurate, detailed claim file documentation in compliance with carrier and program guidelines.
    • Preparing written reports and roundtable summaries consistent with company policies and procedures.

Requirements

• Minimum of 10 years of claims experience, with an emphasis on complex Allied Health claims.
• College degree or equivalent claims management experience required.
• Minimum of 10 years litigation management experience preferred.
• Must hold an individual adjusting license for a designated home State and be willing to secure additional required adjusting licenses as needed.
• Active adjusters license under your name required.
• Proficient computer skills including Microsoft Outlook, Word, and Excel.
• Ability to maintain consistent and clear communication with leadership, the team and all other external points of contact.

Qualifications

• Minimum of 10 years of claims experience, with an emphasis on complex Allied Health claims.
• College degree or equivalent claims management experience required.
• Minimum of 10 years litigation management experience preferred.
• Must hold an individual adjusting license for a designated home State and be willing to secure additional required adjusting licenses as needed.
• Active adjusters license under your name required.
• Proficient computer skills including Microsoft Outlook, Word, and Excel.
• Ability to maintain consistent and clear communication with leadership, the team and all other external points of contact.

Skills

• Claims experience, particularly in complex Allied Health claims.
• Legal liability analysis and interpretation.
• Medico-legal documentation and reporting.
• Expert witness coordination and testimony.
• Claims management software proficiency.
• Communication and collaboration skills.

Benefits

• Comprehensive benefits including medical, dental and vision insurance, 401(k) plan with match, paid time off, and other benefits.
• Employee Ownership Program.
• Professional development opportunities.
• Owner Referral Program.
• Work from home reimbursement for remote/hybrid roles.
• Canary emergency financial assistance program.
• Life/AD&D Insurance.
• Confidential, Employee Assistance Program.
• Health Savings Account, includes company contribution.
• Short-term disability.
• Voluntary benefits - supplemental accident, critical illness, hospital insurance.
• Employee discounts.
• Various Time Off Programs.
• 11 company paid holidays.

Pay

The starting annual pay scale for this position is listed below. Actual starting pay will be based on factors such as skills, qualifications, training, and experience. In addition, the company offers comprehensive benefits including medical, dental and vision insurance, 401(k) plan with match, paid time off, and other benefits.

National Pay Range: $87,000 USD - $109,000 USD

Schedule

Not specified.

Application Instructions

Not specified.