Complex Loss Specialist (Allied Health)

About the role

Our client is a rapidly growing, technology-driven MGA and insurance wholesaler transforming the specialty insurance market through innovation, data, and advanced technology. This role involves managing the organization's most complex and high-exposure Allied Health, medical malpractice, and professional liability claims. You will handle sophisticated healthcare liability matters, collaborate with key stakeholders, and play a critical role in driving claim outcomes and litigation strategy.

Responsibilities

• Analyze, investigate, evaluate, and manage complex Allied Health, medical malpractice, and professional liability claims from inception through resolution.
• Review coverage, assess liability and damages, analyze medical records, and determine claim exposure on high-severity losses.
• Partner closely with insureds, brokers, defense counsel, experts, underwriters, and other stakeholders throughout the claims process.
• Direct litigation strategy, retain and manage defense counsel, and oversee claim-related activities to achieve favorable outcomes.
• Establish and maintain appropriate reserves, evaluate settlement opportunities, and provide recommendations on high-exposure claims.
• Prepare comprehensive claim reports, maintain accurate file documentation, and communicate claim developments to management.
• Conduct detailed investigations through the collection and analysis of medical records, contracts, witness statements, and other supporting documentation.
• Present complex claims to senior leadership and participate in strategy discussions regarding claim resolution, litigation management, and exposure mitigation.

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 licenses as needed.