Senior Claims Examiner, Medical & Healthcare Claims

Responsibilities

• Handles healthcare malpractice/negligence claims including the following:
• Analyzes coverage and communicates coverage positions
• Coordinates and directs investigation into loss facts and extent of damages
• Confirms coverage of claims by reviewing policies and documents submitted in support of claims
• Drafts coverage position letters
• Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure
• Handles claims in all jurisdictions
• Handles litigated and non-litigated bodily injury claims with values up to $450,000 in all jurisdictions, managing the process from inception of the claim until conclusion, including settlement, trial, or appeal, when litigated.
• Maintains monitors excess and reinsurance claim files with varying levels of attachment point
• Identifies losses which should be reported to SIU
• Participates in special projects or assists other team members as requested
• Represents Markel in mediations, as required
• Monitors trial, as required
• Sets reserves within authority or makes recommendations concerning reserve changes to manager
• Provides excellent and professional customer service to insureds while maintaining a high level of production
• Represents Markel in mediations, as required
• Monitors trial, as required

Requirements

• Bachelor’s degree or equivalent work experience
• JD, advanced degree, or focused technical degree a plus
• Certification must have or be eligible to receive claims adjuster license
• Successful achievement of industry designations (INS, IEA, AIC, ARM, SCLA, CPCU) or Participation in industry training opportunities (CLM Claim College, Munich Re Training, FDCC, etc.)

Skills

• Excellent written and oral communication skills
• Strong analytical and problem solving skills
• Strong organization and time management skills
• Experience in negotiation, mediations, arbitrations and monitoring trials on higher value complex claims
• Ability to influence claims stakeholders and to effectively direct claims strategy
• Strong vendor management skills are required including the ability to provide direction and guidance to defense attorneys, independent adjusters, building consultants, forensic accountants and other experts while controlling expenses
• Ability to assist with technical training to team claim handlers as required
• Well developed and advanced expertise and knowledge in most technically complex claims topics
• Policy language skills enabling accurate and consistent policy wording interpretation
• Experience in effectively following up on recommendations from technical claims audits and continuous file handling improvement
• Ability to deliver outstanding customer service
• Intermediate skills in Microsoft Office products (Excel, Outlook, Power Point, Word)
• Ability to work in a team environment
• Strong desire for continuous improvement

Benefits

Competitive benefit programs that help meet our diverse and changing environment as well as support our employees’ needs at all stages of life. All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance. We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave.