Complex Loss Specialist (Allied Health)
New
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Integrated Specialty Coverages, LLCInsurance
Remote United StatesFull-TimeSenior
Salary87,000 - 109,000 USD per year
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Job Details
- Experience
- Minimum of 10 years of claims experience
- Required Skills
- Microsoft Excel
Requirements
- Minimum of 10 years of claims experience, with an emphasis on complex Allied Health claims.
- Active adjuster license under your name.
- Must hold an individual adjusting license for a designated home State.
- Willingness to secure additional required adjusting licenses as needed.
- College degree or equivalent claims management experience.
- Minimum of 10 years litigation management experience preferred.
- Proficient computer skills including Microsoft Outlook, Word, and Excel.
- Ability to interpret medical records across allied health disciplines.
- Knowledge of Fair Claims Practices 790.03 guidelines.
- Ability to maintain clear communication with leadership and external points of contact.
Responsibilities
- Adjust time-intensive, complex, and high exposure Allied Health claims.
- Conduct coverage analysis and identify potential coverage questions.
- Draft reservation of rights and coverage denials for management review.
- Investigate facts of loss by securing statements and supporting documentation.
- Manage litigation by assigning and directing defense counsel, independent adjusters, and experts.
- Evaluate, set, and recommend reserves based on exposure and claim trajectory.
- Lead strategic roundtable discussions to determine resolution strategy.
- Present analysis and status updates to Senior and Program Executives.
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