Complex Loss Specialist (Allied Health)
I
Integrated Specialty CoveragesInsurance claims
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, with an emphasis on complex Allied Health claims. Minimum of 10 years litigation management experience preferred.
- Required Skills
- Microsoft Excel
Requirements
- Minimum of 10 years of claims experience, with an emphasis on complex Allied Health claims.
- A college degree or equivalent claims management experience is required.
- An active adjuster's license under your name is required.
- Must hold an individual adjusting license for a designated home State and be willing to secure additional required adjusting licenses as needed.
- Minimum of 10 years of litigation management experience preferred.
- Proficient computer skills, including Microsoft Outlook, Word, and Excel.
- Ability to maintain consistent and clear communication with leadership, the team, and external contacts.
Responsibilities
- Investigate and evaluate healthcare liability claims, including medical malpractice, general liability, and professional liability exposures.
- Research and interpret Allied Health professional liability policy coverage, including dates, limits, exclusions, and endorsements.
- Secure statements and supporting documentation, including medical records, contracts, incident reports, estimates, and expert reports.
- Draft reservation of rights letters and coverage denials for supervisor review and approval.
- Apply legal liability and exercise settlement authority within assigned limits.
- Assign and direct defense counsel, independent adjusters, medical examiners, and expert witnesses.
- Evaluate, set, or recommend reserves based on exposure analysis and claim trajectory.
- Maintain detailed claim file documentation and prepare reports and roundtable summaries.
- Provide claim status updates to insureds, claimants, underwriters, and carriers.
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