Complex Claims Specialist
Core
Adjusts and resolves complex mid to high-severity Allied Healthcare Professional Liability claims from inception to resolution, including all phases of litigation.
Role type
Senior IC claims specialist (professional liability)
Builds
Defense strategy and claim outcomes for insureds and broker partners
Domain
Insurance / Professional Liability / Allied Healthcare
Required skills
Professional liability claims handling, Medical malpractice claims handling, Litigation process management, Coverage analysis, Investigation, Negotiation, Alternative dispute resolution, Fraud detection, Mentoring, Regulatory compliance
Preferred skills
JD from ABA accredited law school, Experience leading mediations, arbitrations and trials, Product innovation
Technologies
None stated
Responsibilities
Adjusts and resolves complex mid to high-severity claims, Drafts complex coverage letters including reservation of rights and denial letters, Reviews and provides analysis of claim documentation and legal filings, Drives litigation best practices to lead defense strategy, Mentors team members, Identifies emerging exposures and claims trends, Identifies suspected fraudulent claims and tracks with special investigations unit, Accurately documents claim files in compliance with policies and regulatory authorities
Seniority
Senior, hands-on IC