Fraud Triage Specialist responsible for identifying fraud indicators in insurance claims. Analyzing information and collaborating with investigative teams within the Claims department.
About the role
- Complex Claims Specialist handling Miscellaneous Professional Liability claims from inception to resolution at Hiscox. Involves negotiation, settlement, and litigation support with a focus on positive outcomes.
Responsibilities
- Handle Miscellaneous Professional Liability claims for the organization from inception to resolution
- Negotiate and settle Miscellaneous Professional Liability insurance claims
- Responsible for all aspects of the claims, including liaise with external and internal business partners (e.g., outside experts and/or or legal counsel; underwriting)
- Adjust and resolve complex to severe claims that include all phases of litigation
- Draft complex coverage letters, including reservation of rights and denial letters with minimal supervision
- Review and analyze claim documentation and legal filings
- Drive litigation best practices to lead defense strategy on litigated files
- Mentor Claim Examiners
- Identify emerging exposures and claims trends
- Accurately document claim files with all relevant claim documentation, correspondence and notes
Requirements
- 8+ years of claims handling experience or 7-8 years litigation 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
- 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 from an accredited College or University preferred
- Ability to act a subject matter expert within team
- Demonstrated ability to work with minimal oversight
- Experience attending and leading mediations, arbitrations and trials
- Demonstrated ability to advance product innovation or develop a greater understanding of other aspects of the business through training or other relevant projects
- Demonstrates courage in addressing and solving difficult or complex matters with insureds, attorneys and brokers
- Demonstrated steps taken toward additional certifications by an approved authority such as a CPCU, ARMS or AINS designation
- Commitment to professional development and learning demonstrated by at least 5 hours of continuing education related to insurance topics through Success Factory, Hiscox in-person or video conference training sessions, or other in-person seminars or webinars.
Benefits
- 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 plus 2 Hiscox days,10 paid holidays plus 1 paid floating holiday, and ability to purchase up to 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
- 2023 Gold level recipient of Cigna’s Healthy Workforce Designation for having a best-in-class health and wellness program
- Dynamic, creative and values-driven culture
- Modern and open office spaces, complimentary drinks
- Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation
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