Senior Claims Specialist, HMO & PEI Claims
Core
Manages specialty lines claims across the full lifecycle from investigation to settlement and closure for HMO and Provider Excess (PEI) accounts.
Role type
Senior Claims Specialist (HMO & PEI)
Builds
Settled claims and resolved litigation cases
Domain
Insurance / Health & Pensions
Required skills
Claims lifecycle management, Coverage analysis, Reserve setting, Litigation management, Mediation & arbitration, Regulatory compliance, Broker & reinsurer engagement, Insurance law knowledge, Negotiation, Trend identification
Preferred skills
Advanced degree, Experience in legal or related fields
Technologies
CMS, Insurance adjuster licenses
Responsibilities
Analyze and evaluate losses to determine coverage and claim disposition; Establish and review indemnity and expense reserves; Manage litigation process including counsel retention and case resolution; Participate in mediations and arbitrations; Identify emerging claim trends and communicate findings to management; Support claims marketing by engaging with brokers and risk managers.
Seniority
Senior, hands-on IC (via careerplan.io/jobs/618519922928-senior-claims-specialist-hmo-pei-claims-at-libertymutual)