Core Specialty Insurance Holdings, Inc. provides specialty insurance through a group of subsidiary insurers serving small and mid-sized businesses. Its portfolio spans property and short-tail agriculture, equine, marine and energy, specialty casualty, and healthcare professional liability coverage. The company works through autonomous divisions, with a focus on local distribution and underwriting expertise across niche markets.
Senior Commercial Healthcare Claims Examiner
Manage complex commercial healthcare claims across the U.S. for Core Specialty Insurance. Oversee casualty portfolios, reserves, vendors, litigation, and mediations.
Apraksts
- Handle commercial healthcare claims across the U.S.
- Apply claim handling guidelines for coverage, investigation, liability, damages, evaluation, and resolution.
- Manage primary casualty portfolios and maintain contact with insureds, agents, and brokers.
- Oversee excess casualty claims managed by third-party administrators (TPAs).
- Manage allocated loss adjustment expenses (ALAE) by selecting, instructing, and overseeing vendors.
- Review claim information, make evaluations and decisions within delegated authority, resolve claims, and identify settlement issues.
- Set reserves in line with reserving protocols and authority procedures.
- Resolve complex or high-exposure claims and play a substantial role in mediation negotiations.
- Follow the Panel Counsel Program and Litigation Management Guidelines.
- Submit accurate and timely reports, including Large Loss Reports.
- Coordinate with underwriting on claim trends and other relevant topics.
- Respond to external customers, resolve issues, and maintain positive working relationships.
- Attend mediations or trials as required.
- Perform general office administration as needed.
- Keep current with market and industry developments and attend continuing education when available.
- Perform other duties reasonably assigned by the Company.
Prasības
- A college degree or equivalent experience is required.
- An adjuster license in the applicant’s home state is required; licenses in multiple states are preferred.
- At least three years of claims adjusting or legal experience is required.
- Experience with U.S. healthcare professional or general liability claims is preferred.
- Previous work as a healthcare professional or medical malpractice attorney is an advantage.
- Experience handling primary and excess claims is required.
- Reinsurance experience is preferred.
- Must be able to travel for meetings, mediations, and trials as needed.
- Negotiation skills and the ability to persuade are required.
- Strong communication and writing skills are required.
- Must be detail-oriented and organized.
- Must be able to work independently and as part of a team.
- Must be proactive and able to solve problems.
- Must manage pending claims and other projects while meeting management deadlines.
- A general understanding of state and federal laws governing U.S. specialty healthcare claims is required.
- A general understanding of policy language and coverage applicable to U.S. specialty healthcare is required.
- Knowledge of medical terminology is required.
- Applicants must be authorized to work for any U.S. employer.
- Work visa sponsorship is unavailable now and in the future.
Priekšrocības
- Competitive salary.
- Professional development and advancement opportunities.
- Medical insurance.
- Dental insurance.
- Vision insurance.
- Life insurance.
- Short-term disability coverage.
- Long-term disability coverage.
- 401(k) plan with a 100% company match on contributions up to 6%.
- Employee Assistance Plan.
- Health Savings Account.
- Flexible Spending Account.
- Health Reimbursement Account.
- Wellness program.