Claims Examiner processing and adjudicating healthcare claims at WebTPA. Involves claims research and verifying insurance coverage in a customer service role.
About the role
- Senior Complex Claims Specialist managing high-severity professional liability claims for Hiscox. Collaborating with business leaders and providing technical support in a hybrid role.
Responsibilities
- Responsible for the handling of high-severity primary Professional Lines including Miscellaneous Professional Liability, A&E, Allied Health, and Media claims from inception to resolution.
- Adjusts to resolution the highest severity claims and drafts complex technical coverage analysis and letters required in the given claim department.
- Acts as subject matter expert within the team.
- Models gold standard for litigation best practices and file integrity.
- Uses superior knowledge and experience to affect positive claim outcomes via investigation, negotiation and alternative dispute resolutions.
- Identifies and provides potential solutions for emerging exposures and claims trends.
- Accurately documents claim files with all relevant correspondence and notes.
- Mentors other team members and develops content and conducts training for claims team and underwriters as requested.
Requirements
- 10+ years of Professional Liability and/or Specialty 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 highest severity claims outcomes through investigation, negotiation and effectively leading litigation
- Ability to work in a fast-paced and changing environment
- Expert knowledge of coverage within the team’s specialty or focus
- Expert knowledge of litigation process and negotiation skills
- Proven track record of mentoring others
- Excellent verbal and written communication skills
- Advanced analytical skills
- B.A./B.S Degree required, JD optimal
- Adjuster licensing required or ability to obtain within 90 days of employment
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
- 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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