Claims Specialist III

We are seeking a Complex Claims Consultant – Medical Malpractice to independently manage a high-volume portfolio of complex claims.

In this fully remote role, you will be responsible for evaluating policy coverage, managing complex litigation, partnering with defense counsel, and executing strategic settlement negotiations. You will serve as a technical subject matter expert, managing large exposure inventories while ensuring exceptional service, accurate reserving, and effective cost management.

Top Requirements We Look For On Your Resume

• High-Volume Malpractice Experience: 5+ years of experience independently managing a large inventory (130+ active files) of high-exposure medical malpractice claims.

• Mastery of Negotiation: Proven track record of executing high-stakes settlement strategies and negotiating complex resolutions.

• Demonstrated Critical Thinking: Superior analytical and investigative skills to navigate coverage nuances, evaluate liability/damages, and drive sound business decisions.

Qualifications & Skills

• Education: Bachelor’s Degree or equivalent professional experience required.

• Experience:
  
  
  • Minimum of 4+ years of relevant insurance claim-handling experience (5+ years strongly preferred).
    
    
  • Special Consideration: Candidates who have successfully completed the CNA Claim Training Program may be considered with 2+ years of claim-handling experience.
    
    

Technical Knowledge: Deep understanding of the professional liability insurance landscape, product structures, policy language, and standard claim practices.

Core Competencies:

• Exceptional written and verbal communication skills, including the ability to present technical information clearly to executive leadership.

• Analytical and investigative mindset with proven critical-thinking capabilities.

• strong organization skills to balance quality and cycle-time standards across a large claim volume.

Work Environment & Opportunities

• 100% Remote Flexibility: Work from home anywhere in the country.

• Project Extension: This role offers strong potential for contract extensions based on operational demand and performance.

salary: $30 - $48 per hour
shift: First
work hours: 8 AM - 4:30 PM
education: Bachelors

Responsibilities

Key Responsibilities

• Claims Management & Resolution: Independently manage a heavy inventory of complex professional liability claims with high financial exposure. Develop and execute tailored resolution strategies, authorize disbursements within authority limits, and negotiate complex settlements.

• Coverage & Reserving: Analyze and interpret policy language to verify coverage and establish timely, adequate reserves. Partner with coverage counsel on intricate legal matters.

• In-Depth Investigations: Lead investigations to evaluate liability, compensability, and damages. Take recorded statements, gather contract and medical evidence, and collaborate with industry experts.

• Litigation & Budget Oversight: Partner closely with defense counsel to guide litigation strategy. Establish and manage claim budgets, control defense costs, and oversee expert resource spending.

• Stakeholder Communication: Maintain exceptional customer service across all touchpoints. Keep senior leadership updated on high-risk losses through clear, concise loss summaries and watch-list reporting.

• Fraud & Subrogation Identification: Identify potential subrogation/salvage opportunities and flag fraudulent activity for referral to SIU/Recovery units.

• Compliance & Expertise: Maintain up-to-date knowledge of commercial insurance laws, state/local regulations, and industry trends to ensure strict compliance and quality standards.

Skills

• Claims Processing
• Claims
• Workers Compensation Reporting Claims
• Analytical Thinking
• Responsiveness
• Confidentiality
• Verbal Communication
• Filing
• Basic Software Skills

Qualifications

• Years of experience: 10 years
• Experience level: Experienced

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.