Job SummaryThe Complex Loss Specialist position at Golden State Claims Services reports to a Claims Supervisor or Claims Manager and will specialize in
Allied Health claims. The chief duty of the Complex Loss Specialist for Allied Health claims is to adjust the most time-intensive, complex, and high exposure losses that require a higher level of technical expertise, knowledge, and negotiating ability, for the program(s) to which is assigned. The Complex Loss Specialist will have a high level of ability to provide analysis and presentations to Senior Executives and Program Executives for these complex matters and will be well-versed in leading strategic roundtable discussions to determine optimal resolution strategy.
Position Responsibilities- Contribute to a collaborative environment by consistently demonstrating teamwork, high motivation, positive behavior, and effort to achieve goals and objectives.
- Building and maintaining productive relationships with internal and external customers, including clients, underwriting and service teams, and agents
- Research applicable coverage for our insureds. Document coverage dates, limits, and restrictions
- Identify and resolve any potential coverage questions. Draft reservation of rights and coverage denials for review and approval by their Supervisor/Manager
- Investigate facts of the loss by securing statements and supporting documentation such as contracts, cost of repair estimates, expert reports, photos, correspondence, etc.
- Document activities in writing within claim files
- Exercise judgment in applying legal liability to assigned claims and will have settlement authority up to their specific authority, which may vary from carrier to carrier.
- Assign defense counsel to answer and defend lawsuits where appropriate. Monitor and direct defense counsel, independent adjusters, and experts.
- Identify claims with potential exposure in excess of authority and advise their Supervisor/Manager
- Evaluate, set, or recommend reserves for each file they are handling.
- Prepare written reports as dictated by company policy and procedures.
- Handle claims within guidelines of the Fair Claims Practices 790.03
- Provide insureds, claimants, underwriters, and carriers with regular updates on status of file handling.
- Discuss unique and complex files with Supervisor/Manager
Core Technical Duties- Healthcare liability claims investigation and evaluation, including medical malpractice, general liability, and professional liability exposures
- Coverage analysis and interpretation of allied health professional liability policies, including review of coverage dates, limits, exclusions, and endorsements
- Medical record review and interpretation across allied health disciplines (physical therapy, home health, diagnostics, behavioral health, etc.)
- Drafting reservation of rights letters and coverage denial communications for supervisor review
- Reserve evaluation, setting, and recommendation based on exposure analysis and claim trajectory
- Litigation management, including assignment and direction of defense counsel, independent medical examiners, and expert witnesses
Investigation & Documentation- Securing recorded and written statements from insureds, claimants, and witnesses
- Gathering and organizing supporting documentation including incident reports, medical records, licensing records, contracts, and expert reports
- Maintaining accurate, detailed claim file documentation in compliance with carrier and program guidelines
- Preparing written reports and roundtable summaries consistent with company policies and procedures
Minimum Qualifications- Minimum of 10 years of claims experience, with an emphasis on complex Allied Health claims
- College degree or equivalent claims management experience required.
- Minimum of 10 years litigation management experience preferred.
- Must hold an individual adjusting license for a designated home State and be willing to secure additional required adjusting licenses as needed
- Active adjusters license under your name required
- Proficient computer skills including Microsoft Outlook, Word, and Excel.
- Ability to maintain consistent and clear communication with leadership, the team and all other external points of contact
The starting annual pay scale for this position is listed below. Actual starting pay will be based on factors such as skills, qualifications, training, and experience. In addition, the company offers comprehensive benefits including medical, dental and vision insurance, 401(k) plan with match, paid time off, and other benefits.
ISC's salary ranges are determined by role and level. The range displayed on each job posting reflects the minimum and maximum target for new hire salaries for the position across all US locations and could be higher or lower based on a multitude of factors, including job-related skills, experience, and relevant education or training.
National Pay Range
$87,000-$109,000 USD
Benefits of Working at ISC- Employee Ownership Program - every eligible employee shares in the financial rewards that grow when the company grows
- Professional development opportunities
- Owner Referral Program
- Work from home reimbursement for remote/hybrid roles
- Canary emergency financial assistance program
- Comprehensive medical, dental, vision
- Life/AD&D Insurance
- Confidential, Employee Assistance Program
- Health Savings Account, includes company contribution
- Short-term disability
- Voluntary benefits - supplemental accident, critical illness, hospital insurance
- Employee discounts
- 401(k) Plan with company match contribution
- Addition Wealth Financial Wellness Program
- Various Time Off Programs
- 11 company paid holidays
