Job Type:Permanent
**Please Note: This position is primarily hybrid and requires in-office attendance at least two (2) days per week for candidates that are located near one of our office locations. However, qualified remote candidates will also be considered**The Position Can Be Based In:- Atlanta, GA
- Boston, MA
- Chicago, IL
- Manhattan, NY
- Scottsdale, AZ
- West Hartford, CT
The Role:The Senior Claims Examiner-Allied Healthcare handles assigned claims within given authority and according to Hiscox Claims Best Practices.
Role Responsibilities:- Analyze professional liability exposures involving Allied Healthcare providers, facilities, and services.
- Interpret policy language, endorsements, exclusions, limits, retentions, and coverage triggers specific to Allied Healthcare risks.
- Develop and maintain claim action plans addressing coverage, liability, damages, litigation strategy, reserves, and resolution opportunities.
- Conduct timely investigations, including review of medical records, provider documentation, licensing information, contracts, and applicable standards of care.
- Evaluate complex causation and damages issues with defense counsel, medical experts, and other consultants.
- Manage litigation through trial, including counsel selection, budgets, legal strategy, expert retention, mediation, settlement conferences, and trial preparation.
- Identify matters requiring escalation based on severity, coverage complexity, reputational risk, regulatory exposure, or potential excess involvement.
- Present significant or high-exposure claims at roundtables and clearly document decisions and follow-up actions.
- Maintain accurate diaries, reserves, litigation plans, and reporting in accordance with internal Best Practices and regulatory requirements.
- Collaborate with underwriting, actuarial, risk management, brokers, and insureds to identify claim trends and risk-improvement opportunities.
- Deliver responsive, empathetic service to insured professionals and organizations during sensitive claim situations.
Requirements:- 1-3 years of claims handling experience with an insurance carrier, third-party administrator, law firm, healthcare organization, or related industry experience preferred. Experience handling Professional Liability, Allied Healthcare, Medical Malpractice, Long-Term Care, or Bodily Injury claims is a plus.
- Basic understanding of claims investigation, evaluation, and coverage analysis, with the ability to gather facts, review documentation, and identify key issues impacting claim resolution.
- Developing knowledge of reserve practices, including the ability to establish and adjust reserves with guidance based on liability, damages, and emerging claim information.
- Familiarity with claims-handling regulations, statutes of limitation, and jurisdictional considerations, or the ability to quickly learn and apply regulatory requirements.
- Ability to manage a caseload of low to moderate complexity claims while maintaining accurate documentation, diary management, and timely communication with insureds, brokers, counsel, and business partners.
- Demonstrated problem-solving and analytical skills, with the ability to identify potentially complex, sensitive, or high-exposure matters and escalate appropriately.
- Exposure to litigated claims or legal processes preferred, with an interest in developing skills related to litigation management, defense counsel oversight, and dispute resolution.
- Ability to review and analyze medical records, legal documents, and claim-related information to support claim evaluation and decision-making.
- Strong negotiation, communication, and customer service skills, with the ability to build effective relationships with insureds, brokers, healthcare providers, attorneys, and internal stakeholders.
- Proficiency with Microsoft Office applications and the ability to learn claims management systems.
- Active adjuster's license preferred but not required; ability to obtain required licensing within 90 days of employment.
- Bachelor's degree from an accredited college or university required; coursework or experience in insurance, healthcare, legal studies, risk management, or a related field is preferred.
Key Competencies:- Strong organizational and time-management skills.
- Attention to detail and sound judgement.
- Customer-focused mindset.
- Effective written and verbal communication.
- Ability to learn quickly and adapt in a fast-paced environment.
- Collaborative approach to working with colleagues and business partners.
What Hiscox USA Offers:- 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
- Recipient of 2024 Cigna's Well-Being Award for having a best-in-class health and wellness program
- Dynamic, creative and values-driven culture
- Modern and open office spaces, complimentary drinks
Salary Range: $95-$120kThe actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
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