Complex Loss Specialist – Allied Health

This is a fully remote position, open to applicants in United States.

📋 Description

• Contribute to a team-oriented environment by consistently showcasing teamwork, high motivation, positive behavior, and dedicated effort to meet goals and objectives.

• Develop and sustain productive relationships with both internal and external customers, which include clients, underwriting and service teams, as well as agents.

• Conduct research on applicable coverage for our insured clients. Record coverage dates, limits, and restrictions meticulously.

• Identify and address any potential coverage inquiries. Prepare reservation of rights and coverage denial documents for review and approval by the Supervisor/Manager.

• Investigate the details of the loss by obtaining statements and supporting documentation such as contracts, cost estimates for repairs, expert reports, photographs, correspondence, and more.

• Maintain written records of activities within claim files.

• Utilize judgment in applying legal liability to assigned claims and possess settlement authority up to a specific limit, which may differ from carrier to carrier.

• Assign defense counsel to respond to and defend lawsuits where appropriate. Oversee and direct defense counsel, independent adjusters, and experts involved.

• Recognize claims with potential exposure exceeding authority and inform the Supervisor/Manager accordingly.

• Assess, set, or suggest reserves for each file under their management.

• Generate written reports as per company policy and procedures.

• Manage claims in accordance with the Fair Claims Practices 790.03.

• Provide insured individuals, claimants, underwriters, and carriers with regular updates regarding the status of file management.

• Consult with Supervisor/Manager on unique and complex files.

⛳️ Requirements

• A minimum of 10 years of claims experience, particularly focused on complex Allied Health claims.

• A college degree or equivalent experience in claims management is required.

• At least 10 years of litigation management experience is preferred.

• Must possess an individual adjusting license for a designated home state and be willing to obtain any additional required adjusting licenses as necessary.

• An active adjuster's license in your name is required.

• Strong computer skills, including proficiency in Microsoft Outlook, Word, and Excel.

• Capacity to maintain consistent and clear communication with leadership, the team, and all other external contacts.

🏝️ Benefits

• Employee Ownership Program - every eligible employee participates in financial rewards that grow alongside the company.

• Opportunities for professional development.

• Owner Referral Program.

• Work from home reimbursement for remote or hybrid positions.

• Canary emergency financial assistance program.

• Comprehensive medical, dental, and vision coverage.

• Life/AD&D Insurance.

• Confidential Employee Assistance Program.

• Health Savings Account, with a company contribution included.

• Short-term disability benefits.

• Voluntary benefits, including supplemental accident, critical illness, and hospital insurance.

• Discounts for employees.

• 401(k) Plan featuring company match contributions.

• Additional Wealth Financial Wellness Program.

• Various Time Off Programs.

• 11 company-paid holidays.