Senior Claims Examiner – Allied Healthcare

• Handle assigned claims within given authority and according to Hiscox Claims Best Practices
• Analyze professional liability exposures involving Allied Healthcare providers, facilities, and services
• Interpret policy language, endorsements, exclusions, limits, retentions, and coverage triggers
• Develop and maintain claim action plans covering coverage, liability, damages, litigation strategy, reserves, and resolution opportunities
• Conduct timely investigations 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 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 round tables and 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

• 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
• Ability to gather facts, review documentation, and identify key issues impacting claim resolution
• Developing knowledge of reserve practices, including establishing and adjusting reserves with guidance
• Familiarity with claims-handling regulations, statutes of limitation, and jurisdictional considerations, or ability to quickly learn and apply regulatory requirements
• Ability to manage a caseload of low to moderate complexity claims with accurate documentation, diary management, and timely communication
• Problem-solving and analytical skills, including identifying and escalating potentially complex, sensitive, or high-exposure matters
• Exposure to litigated claims or legal processes preferred
• Ability to review and analyze medical records, legal documents, and claim-related information
• Strong negotiation, communication, and customer service skills
• Proficiency with Microsoft Office applications and 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 preferred
• 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

Demonstrates expertise in claims handling, particularly in Professional Liability and Allied Healthcare, with a strong focus on regulatory compliance, effective communication, and problem-solving. Capable of managing complex claims, conducting thorough investigations, and collaborating with various stakeholders to achieve optimal outcomes.

• Claims Handling Experience
• Professional Liability Expertise
• Regulatory Compliance Knowledge
• Strong Negotiation Skills
• Effective Communication

• Claims Investigation
• Coverage Analysis
• Reserve Practices
• Medical Record Review
• Legal Document Analysis
• Litigation Management
• Claims Management Systems
• Documentation Management
• Risk Management
• Problem-Solving

• Customer-Focused Mindset
• Attention to Detail
• Organizational Skills
• Time-Management Skills
• Empathetic Service

• Active Adjuster's License

• Allied Healthcare
• Medical Malpractice
• Long-Term Care
• Bodily Injury
• Claims Best Practices
• Statutes of Limitation
• Jurisdictional Considerations
• Insurance
• Healthcare
• Legal Studies

• Microsoft Office Applications