Senior Claims Examiner - Allied Healthcare

Handle assigned claims within given authority and according to Hiscox Claims Best Practices Analyze professional liability exposures involving Allied Healthcare providers, facilities, and services Interpret policy language, endorsements, exclusions, limits, retentions, and coverage triggers Develop and maintain claim action plans covering coverage, liability, damages, litigation strategy, reserves, and resolution opportunities Conduct timely investigations of medical records, provider documentation, licensing information, contracts, and applicable standards of care Evaluate complex causation and damages issues with defense counsel, medical experts, and consultants Manage litigation through trial, including counsel selection, budgets, legal strategy, expert retention, mediation, settlement conferences, and trial preparation Identify matters requiring escalation based on severity, coverage complexity, reputational risk, regulatory exposure, or potential excess involvement Present significant or high-exposure claims at roundtables and document decisions and follow-up actions Maintain accurate diaries, reserves, litigation plans, and reporting in accordance with internal Best Practices and regulatory requirements Collaborate with underwriting, actuarial, risk management, brokers, and insureds to identify claim trends and risk-improvement opportunities Deliver responsive, empathetic service to insured professionals and organizations during sensitive claim situations Requirements 1-3 years of claims handling experience with an insurance carrier, third-party administrator, law firm, healthcare organization, or related industry experience preferred Experience handling Professional Liability, Allied Healthcare, Medical Malpractice, Long-Term Care, or Bodily Injury claims is a plus Basic understanding of claims investigation, evaluation, and coverage analysis Ability to gather facts, review documentation, and identify key issues impacting claim resolution Developing knowledge of reserve practices, including establishing and adjusting reserves with guidance Familiarity with claims-handling regulations, statutes of limitation, and jurisdictional considerations, or ability to quickly learn and apply regulatory requirements Ability to manage a caseload of low to moderate complexity claims with accurate documentation, diary management, and timely communication Problem-solving and analytical skills, including identifying and escalating potentially complex, sensitive, or high-exposure matters Exposure to litigated claims or legal processes preferred Ability to review and analyze medical records, legal documents, and claim-related information Strong negotiation, communication, and customer service skills Proficiency with Microsoft Office applications and ability to learn claims management systems Active adjuster's license preferred but not required; ability to obtain required licensing within 90 days of employment Bachelor's degree from an accredited college or university required Coursework or experience in insurance, healthcare, legal studies, risk management, or a related field preferred Strong organizational and time-management skills Attention to detail and sound judgement Customer-focused mindset Effective written and verbal communication Ability to learn quickly and adapt in a fast-paced environment Collaborative approach to working with colleagues and business partners Core Competencies Demonstrates expertise in claims handling, particularly in Professional Liability and Allied Healthcare, with a strong focus on regulatory compliance, effective communication, and problem-solving. Capable of managing complex claims, conducting thorough investigations, and collaborating with various stakeholders to achieve optimal outcomes. Highest-signal resume keywords Claims Handling Experience Professional Liability Expertise Regulatory Compliance Knowledge Strong Negotiation Skills Effective Communication ATS Optimization Keywords Hard Skills Claims Investigation Coverage Analysis Reserve Practices Medical Record Review Legal Document Analysis Litigation Management Claims Management Systems Documentation Management Risk Management Problem-Solving Soft Skills Customer-Focused Mindset Attention to Detail Organizational Skills Time-Management Skills Empathetic Service Certifications & Qualifications Active Adjuster's License Industry Keywords Allied Healthcare Medical Malpractice Long-Term Care Bodily Injury Claims Best Practices Statutes of Limitation Jurisdictional Considerations Insurance Healthcare Legal Studies Tools & Technologies Microsoft Office Applications #J-18808-Ljbffr Jobtailor