Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

Complex Claims Specialist

Full-time

Primma, LLC

**This role is onsite at our Roslyn, NY, Rochester, NY, or Hamilton, NJ office, with the option for a hybrid schedule after the training period. **

General Summary: A Complex Claims Specialist will possess experience in handling complex medical liability claims, while demonstrating a strong client service focus.

Essential Duties & Responsibilities:

  • Follow standard claims protocols for documentation, coverage verification, and file management
  • Maintain accurate and organized claims files, suggesting improvements as necessary.
  • Manage significant client relationships for claims department, collaborate with underwriting on marketing.
  • Investigate and document most significant exposures, setting appropriate indemnity and expense reserves
  • Develop resolutions strategy and lead negotiations and bring matters to a close
  • Attend trials and mediations when necessary
  • Adhere to industry Best Practices for effective claim management
  • Mentor staff through formal and informal training and development; demonstrate extensive technical expertise to guide and support less experienced claims professionals
  • Ensure exceptional data integrity
  • Actively manage defense council and partner on litigation strategy
  • Proactive communication with insureds, other departments and claim leadership
  • Perform additional duties and responsibilities as assigned

Education & Qualifications:

  • Bachelor’s degree or JD required
  • Six years’ claims handling experience required; medical professional liability strongly preferred
  • NY adjusters license required within the first 6 - 12 months of employment
  • Strong analytical and problem-solving skills with attention to detail
  • Demonstrate solid and concise business writing proficiency
  • Exhibit strong oral communication skills to include presenting information clearly and effectively to diverse audiences
  • Ability to work independently as well as assume a mentorship role within a team. Act as a strong example and resource for less experienced colleagues
  • Strong ethical judgement and a commitment to maintaining confidentiality
  • Must be able to work on site
  • Travel required as needed; may include overnight travel

The actual compensation for this position will be determined by experience and other factors permitted by law.

Vacancy posted 18 hours ago
Similar jobs that could be interesting for youBased on the Complex Claims Specialist in Boston, MA vacancy
  • $83k - $154k

    Schedule: Full-Time Salary Range: USD $83000.00 - $154000.00 Job Category: Claims Description Liberty Mutual's Specialized Claims group has an immediate opening on our Complex Construction Claims Team. We're seeking an experienced claims professional who thrives... 
    Suggested
    Full time
    Work at office
    Local area
    Immediate start
    Remote work
    Home office

    Liberty Mutual Insurance

    Boston, MA
    3 days ago
  • $61k - $113k

     ...$61000.00 - $113000.00 Job Category: Claims Description At Liberty, you'll thrive...  ...focused tasks and projects. The Claims Specialist works within a Claims Team, using the...  ...assigned caseload of routine to moderately complex claims from the investigation of the... 
    Suggested
    Full time
    Work experience placement
    Work at office
    Local area
    Remote work

    Liberty Mutual Insurance

    Boston, MA
    4 days ago
  • $67k - $126k

     ...USD $67000.00 - $126000.00 Job Category: Claims Description At Liberty, you'll thrive in...  ...practices, the Technical Claims Specialist is responsible for the investigation, evaluation, and disposition of complex Workers Compensation cases of high exposure... 
    Suggested
    Full time
    Work at office
    Local area
    Remote work

    Liberty Mutual Insurance

    Boston, MA
    5 days ago
  •  ...Claims Specialist Duties: Amwell digitally empowers payers, providers and innovators, enabling an ecosystem of care that spans across in...  ...professional team members. Our day-to-day work involves dealing with complex accounting and tax matters and building sophisticated... 
    Suggested
    Work experience placement
    Immediate start

    Saviance

    Boston, MA
    4 days ago
  • Mass General Brigham Health Plan is seeking a Medicare Advantage Claims Review Specialist to process and adjudicate complex Medicare claims when autoadjudication isn’t achieved. The role requires familiarity with QNXT or similar adjudication systems and strict adherence... 
    Suggested
    Remote job

    Mass General Brigham Health Plan, Inc.

    Somerville, MA
    3 days ago
  •  ...flexibility of remote work for focused tasks and projects. The Senior Claims Specialist works within a Claims Team, using the latest technology to...  ...claims that are routinely characterized as moderately complex to complex within assigned authority limits. This includes making... 
    Work experience placement
    Work at office
    Local area
    Remote work

    Liberty Mutual Insurance

    Boston, MA
    4 days ago
  • $15 per hour

     ...Fortune Best Workplaces in Financial Services & Insurance Claims Assistant PRIMARY PURPOSE OF THE ROLE : To provide support...  ...unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com... 
    Hourly pay
    Work at office
    Local area
    Flexible hours

    Sedgwick

    Boston, MA
    4 days ago
  • $100k - $135k

     ...thing for our customers, teammates, and other stakeholders.A purposely non-bureaucratic organization that embraces simplicity over complexity and emphasizes individual excellence in a team framework.Benefits that support your life and well-being, which include:... 
    Temporary work
    Work at office

    Berkshire Hathaway Specialty Insurance

    Boston, MA
    1 day ago
  • $82k - $153k

     ...insurance, automobile liability and workers' compensation, along with claim services, providing expertise to meet the unique business needs...  ...be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training,... 
    Full time
    Work at office

    Berkley

    Boston, MA
    3 days ago
  •  ...exercising sound judgment and analytical rigor to assess and price complex risks. This role requires making data-driven decisions based on...  ...with internal stakeholders, including Underwriting Support, Claims, Actuarial, and Directors of Underwriting across GRS North... 
    Local area

    Liberty Information Technology Limited

    Boston, MA
    1 day ago
  • $150k - $250k

     ...appropriate policy terms; evaluating due diligence and managing specialist advisors to assist as necessary; reviewing and negotiating...  ...purposely non-bureaucratic organization that embraces simplicity over complexity and emphasizes individual excellence in a team framework.... 
    Temporary work
    Flexible hours

    Berkshire Hathaway Specialty Insurance

    Boston, MA
    3 days ago
  • $115.9k - $152.1k

     ...delivering exceptional experiences for our customers and advisors. As a Life Underwriter , you will play a critical role in evaluating complex life insurance risks, making sound mortality and financial assessments, and partnering with distribution and account management... 
    Permanent employment
    Temporary work
    Remote work

    MassMutual

    Boston, MA
    4 days ago
  • Arbella 56 Group in Quincy, MA is seeking a Claims Service Specialist IV for Commercial Lines Bodily Injury. Under minimal supervision, you will investigate and resolve complex claims, guiding litigation, and mentoring newer staff. The role emphasizes timely case activity... 

    Arbella 56 Group

    Quincy, MA
    4 days ago
  •  ...and overall financial results, while maintaining awareness of claims activity and providing underwriting input on claim resolution.Support...  ...here to learn more on available benefits.Do you like solving complex business problems, working with talented colleagues and have an... 
    Full time
    Temporary work

    Arch Capital Group Ltd.

    Boston, MA
    1 day ago
  •  ...accessible leaders, leveraging our financial strength and vast industry experience to deliver solutions for our clients, no matter how complex. Grow your career with a rapidly growing company that invests in its people and their ability to drive real progress. The Senior... 
    Worldwide

    Starr Insurance

    Boston, MA
    1 day ago
  •  ...Forensics - Insurance and Federal Claims Services - Insurance Adjuster - ManagerLocation...  ...losses. We assist some of the most complex public and private sector entities with...  ...Adjuster, Large Loss Adjuster, Complex Claims Specialist, Business Interruption Adjuster, or... 
    Work at office

    EY

    Boston, MA
    2 days ago
  • $156k - $234k

     ...considering candidates in the NorthEast region. Are you a surety underwriting professional who thrives on building relationships, analyzing complex financials, and making smart, strategic risk decisions? Swiss Re Corporate Solutions is looking for a talented Contract Surety... 
    Contract work
    Temporary work
    For contractors
    Work at office
    3 days per week

    Swiss Re

    Boston, MA
    4 days ago
  • $50k

     ...responsibilities include investigation of Workers Compensation claims to determine either compensability of the claim. This role has...  ...compensation claims. Knowledge of medical terminology involved in complex claims Strong negotiation skills. Skills and Abilities... 
    Remote work
    Flexible hours

    ViziRecruiter

    Quincy, MA
    5 days ago
  • $38.22 per hour

     ...Claims Analyst Trillium Professional is now seeking a Claims Analyst for a contract, remote position in Boston! The assignment...  ...Claims Analyst Pharmacy Revenue Cycle is responsible for managing complex pharmacy insurance claims, denials, and reimbursement issues to... 
    Contract work
    Work at office
    Remote work

    Trillium Staffing

    Boston, MA
    2 days ago
  • $50k - $70k

     ...Job Description Resolute Management, Inc. is a Third-Party Administrator hired by clients to handle complex environmental, asbestos, and/or latent type insurance claims. We are proud to be an affiliate of the Berkshire Hathaway group of insurance companies and we... 
    Full time
    Work at office

    RESOLUTE MANAGEMENT

    Boston, MA
    15 days ago
  •  ...you looking for an opportunity to join a claims team with a fast-growing company that...  ...Claims Representative or Associate Claims Specialist. The salary range posted reflects the range...  ...limits. Write simple to moderately complex property damage estimates or review auto... 
    Work at office
    Local area
    Remote work

    Embedded Shishya

    Boston, MA
    2 days ago
  • $50k - $55k

     ...Fortune Best Workplaces in Financial Services & Insurance Claims Representative, Auto | Property Damage PRIMARY PURPOSE OF THE...  ...unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com... 
    Full time
    Contract work
    Work at office
    Local area
    Flexible hours

    Sedgwick

    Boston, MA
    3 days ago
  • $50k - $55k

     ...Fortune Best Workplaces in Financial Services & Insurance Claims Representative, Auto Job Description PRIMARY PURPOSE OF THE...  ...unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com... 
    Full time
    Contract work
    Work at office
    Local area
    Flexible hours

    Sedgwick

    Boston, MA
    1 day ago
  • Liberty Mutual Insurance is seeking a Claims Specialist in Massachusetts to manage a caseload of routine to moderately complex claims from investigation through resolution. You will decide liability and compensability, evaluate losses, and negotiate settlements while coordinating... 

    Liberty Mutual Insurance

    Lynn, MA
    5 days ago
  • MarineMax Services Inc is seeking a Warranty Administrator to manage the end-to-end warranty claims process for our service facilities in Quincy, MA. You will work with service writers, parts personnel, and the accounting team to maximize reimbursements and ensure compliant... 

    MarineMax Services Inc

    Quincy, MA
    3 days ago
  • $156k - $234k

     ...but not limited to job location, scope of role, qualifications, complexity/specialization/scarcity of talent, experience, education, and...  ...clients mitigate their risk exposure, whilst our industry-leading claims service provides them with additional peace of mind. Our... 
    Contract work
    For contractors
    Work experience placement
    Work at office
    Worldwide
    Flexible hours
    3 days per week

    Swiss Re

    Boston, MA
    4 days ago
  •  ...how service operates. Makes recommendations to service; provides feedback to Service leaders. You're capable of underwriting highly complex business and will require limited support from senior underwriters and infrequent referral activity to complete quotes.... 
    Temporary work
    Flexible hours

    The Hartford

    Boston, MA
    5 days ago
  • $72k - $141k

     ...Strategic Claims Management You have a clear vision of where your career can go. And we have the leadership to help you get there...  ...for the overall strategic management and resolution of highly complex claims that involve personal and advertising injury exposures,... 
    Work experience placement
    Work at office

    CNA

    Boston, MA
    2 days ago
  • $104.8k - $192.3k

     ...Francisco EY's Forensics Insurance and Federal Claims Services practice specializes in helping...  ...other catastrophic losses. We assist complex public and private sector entities with...  ..., Large Loss Adjuster, Complex Claims Specialist, Business Interruption Adjuster, or... 
    Summer holiday
    Work at office
    Flexible hours

    EY

    Boston, MA
    5 days ago
  • $200k - $215k

     ...Establish underwriting standards, best practices, and quality control measures to ensure profitability and compliance. Guide teams on complex risks, market placement strategies, and carrier negotiations. Strengthen carrier partnerships and secure market access, authority,... 
    Full time
    Immediate start
    Flexible hours

    Acrisure

    Boston, MA
    7 hours ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Complex Claims Specialist. Be the first to apply!