Complex Loss Specialist – Allied Health

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

📋 Description

• Adjust the most complex, time-consuming, and high-exposure Allied Health claims that necessitate advanced technical knowledge, expertise, and negotiation skills.

• Provide analysis and presentations to Senior Executives and Program Executives.

• Facilitate strategic roundtable discussions to establish the best resolution strategy.

• Cultivate and sustain relationships with clients, underwriting and service teams, and agents.

• Research relevant coverage and document coverage dates, limits, and restrictions.

• Identify coverage-related questions and draft reservation of rights and coverage denial letters for review.

• Investigate claims by obtaining statements and supporting documentation.

• Document claim activities and maintain precise claim files.

• Apply legal liability principles and exercise settlement authority.

• Assign, oversee, and direct defense counsel, independent adjusters, and experts.

• Identify claims that exceed authority and inform the Supervisor/Manager.

• Evaluate, establish, or recommend reserves.

• Prepare written reports and summaries from roundtable discussions.

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

• Provide regular updates on file status to insured parties, claimants, underwriters, and carriers.

• Conduct investigations and evaluations of healthcare liability claims, including medical malpractice, general liability, and professional liability exposures.

• Analyze coverage for allied health professional liability policies.

• Review and interpret medical records from various allied health disciplines.

• Manage litigation matters, including defense counsel, independent medical examiners, and expert witnesses.

• Collect and organize incident reports, medical records, licensing records, contracts, and expert reports.

⛳️ Requirements

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

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

• A minimum of 10 years of experience in litigation management is preferred.

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

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

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

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

• Must be legally authorized to work in the United States.

🏝️ Benefits

• Employee Ownership Program - every eligible employee shares in the financial rewards that grow as the company grows.

• Opportunities for professional development.

• Owner Referral Program.

• Reimbursement for work-from-home expenses for remote/hybrid roles.

• Canary emergency financial assistance program.

• Comprehensive medical, dental, and vision coverage.

• Life/AD&D Insurance.

• Confidential Employee Assistance Program.

• Health Savings Account, including company contributions.

• Short-term disability coverage.

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

• Employee discounts.

• 401(k) Plan with company matching contributions.

• Additional Wealth Financial Wellness Program.

• Various Time Off Programs.

• 11 company-paid holidays.