Overview In this role you will lead the investigation, management, and resolution of highly complex healthcare claims across multiple states. You will work within the Healthcare Claims team to support diverse providers, applying expert knowledge of policy coverages and claims practices. You will partner with underwriting and legal teams, coordinate litigation or settlements, and ensure timely, compliant outcomes. This is a high-impact role that blends technical claims handling with cross-functional collaboration and ongoing professional development.
Compensation / Benefits- comprehensive benefits package
- flexible, hybrid work schedule
Responsibilities- Manage an inventory of highly complex commercial claims with large exposures using company protocols
- Provide exceptional customer service and timely updates throughout the claim lifecycle
- Verify coverage, reserve adequacy, and liaise with coverage counsel on complex matters
- Lead investigations to establish compensability, liability, and damages
- Negotiate complex settlements and coordinate with counsel on litigation strategy
- Oversee claim budgets and resource allocation
- Identify subrogation/salvage opportunities and refer fraud indicators for investigation
- Mentor and train less experienced claim professionals
- Maintain regulatory compliance and current knowledge of commercial insurance laws
Key requirements- Thorough knowledge of commercial insurance policy language, coverage, and claim practices
- Strong written and verbal communication and presentation skills
- Analytical mindset with ability to resolve complex problems and ambiguous scenarios
- Proven negotiation skills for complex settlements
- Experience interpreting complex policies and coverage
- Ability to manage multiple priorities in a fast-paced environment
- Proficiency with Microsoft Office Suite; ability to learn related software
- Experience in claim handling or medical malpractice litigation; minimum six years
- Ability to obtain/maintain an Insurance Adjuster License within 90 days where applicable
- Professional designations preferred (e.g. CPCU)
- Strong communication and collaboration
- Analytical thinking and critical thinking
- Time management and organizational skills
- Adaptability in a fast-paced environment
- Judgment and professional integrity
- Microsoft Office Suite
