Lead Claims Specialist

This is a fully remote position, open to applicants in Illinois, +1 more state.

📋 Description

• Receive loss reports from healthcare clients and verify that the claims are submitted under the correct policy(ies).

• Investigate policy terms and conditions to assess coverage eligibility and advocate for optimal recovery.

• Provide education and address inquiries from clients concerning claim reporting requirements.

• Act as an advocate for the client, maintaining an active diary, transmitting documentation, and conducting follow-up calls and emails with both the client and carrier.

• Supervise claims with carriers to ensure prompt investigation, liability assessment, litigation, and equitable resolutions.

• Analyze intricate, high-exposure claims and interpret policy language.

• Meet with clients as needed and participate in claim meetings, renewals, and stewardship sessions.

• Serve as a crucial liaison among the client, insurance carrier, defense counsel, and other vendors.

• Conduct Strategic Claim Reviews in collaboration with Loss Control and Analytics.

• Advise clients on cost containment strategies to minimize total claims, loss ratios, financial impacts, timely file closures, and reporting days.

⛳️ Requirements

• Valid Property & Casualty Brokers’ license or adjuster license – Multi State.

• At least 7-10 years of experience as a specialist in a dedicated industry.

• Must have advanced knowledge of Property & Casualty coverages, including Healthcare Medical Professional Liability, Professional and General Liability for healthcare systems, and Cyber Liability.

• Familiarity with Claims Made and Occurrence policy forms, including reporting protocols for healthcare clients.

• Extensive understanding of multi-line coverage and its application within the healthcare sector.

• Demonstrate proficiency in computer applications, particularly the Microsoft Office Suite.

• Ability to deliver exceptional customer service to both external and internal clients.

• Possess strong client advocacy and negotiation skills.

• Capability to conduct strategic claim reviews.

• Expertise in relevant business practice areas.

• Strong claim management and consultative skills.

🏝️ Benefits

• Health insurance.

• 401(k) matching.

• Flexible work hours.

• Paid time off.