Claims Examiner for Workers Compensation analyzing and adjudicating complex claims for various jurisdictions. Working in a hybrid model from Plano, TX or remote for experienced professionals.
About the role
- Complex Claims Specialist handling mid to high-severity Professional Liability claims. Adjusting and resolving claims while mentoring team members and driving defense strategy with external partners.
Responsibilities
- Adjusts and resolves complex mid to severity claims that include all phases of litigation.
- With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters.
- Reviews and provides analysis of claim documentation and legal filings.
- Drives litigation best practices to lead defense strategy on litigated files.
- Mentors team members.
- Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions.
- Identifies emerging exposures and claims trends.
- Identifies suspected fraudulent claims and tracks with special investigations unit.
- Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities.
Requirements
- 6+ years of Professional Liability and/ or Specialty/Financial lines claims handling experience.
- A JD from an ABA accredited law school may be considered as a supplement to claims handling experience.
- Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation.
- Ability to work in a fast-paced and changing environment.
- Advanced knowledge of coverage within the team’s specialty or focus.
- Advanced knowledge of litigation process and negotiation skills.
- Experience in mentoring and training other claims examiners.
- Excellent verbal and written communication skills.
- Advanced analytical skills.
- B.A./B.S Degree required, JD optimal.
- Adjuster licensing is required within 90 days of employment.
Benefits
- Competitive salary and bonus (based on personal & company performance)
- 401(k) with competitive company matching
- Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)
- Company paid group term life, short- term disability and long-term disability coverage
- 24 Paid time off days, 2 Hiscox Days, 10 paid holidays, and ability to purchase 5 PTO days
- Paid parental leave
- 4 week paid sabbatical after every 5 years of service
- Financial Adoption Assistance and Medical Travel Reimbursement Programs
- Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
- Company paid subscription to Headspace to support employees’ mental health and wellbeing
- Dynamic, creative and values-driven culture
- Modern and open office spaces, complimentary drinks
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