Allied Health Complex Loss Specialist

ISC (Integrated Specialty Coverages, LLC); United States; Hybrid; USD 87,000 - 109,000; Full time

Benefits offered by this job

Employee Ownership Program - every-"

Owner Referral Program

Work from home reimbursement forremote

Job summary

Integrated Specialty Coverages, LLC (ISC) is seeking a Complex Loss Specialist focused on Allied Health claims. The role involves adjusting high-exposure losses, presenting analyses to Senior Executives, and leading roundtable discussions to determine optimal resolution strategies.

You will review medical records, draft reservation of rights, manage litigation, and coordinate with defense counsel and experts across nationwide programs, with authority varying by carrier.

Qualifications

• Minimum of 10 years of claims experience, with an emphasis on complex Allied Health claims.
• College degree or equivalent claims management experience required.
• Minimum of 10 years litigation management experience preferred.
• Must hold an individual adjusting license for a designated home State and be willing to secure additional required adjusting licenses as needed.
• Proficient computer skills including Microsoft Outlook, Word, and Excel.
• Ability to maintain consistent and clear communication with leadership, the team and all other external points of contact

Responsibilities

• Contribute to a collaborative environment by consistently demonstrating teamwork, high motivation, positive behavior, and effort to achieve goals and objectives.
• Building and maintaining productive relationships with internal and external customers, including clients, underwriting and service teams, and agents
• Research applicable coverage for our insureds. Document coverage dates, limits, and restrictions
• Identify and resolve any potential coverage questions. Draft reservation of rights and coverage denials for review and approval by their Supervisor/Manager
• Investigate facts of the loss by securing statements and supporting documentation such as contracts, cost of repair estimates, expert reports, photos, correspondence, etc.
• Document activities in writing within claim files
• Exercise judgment in applying legal liability to assigned claims and will have settlement authority up to their specific authority, which may vary from carrier to carrier.
• Assign defense counsel to answer and defend lawsuits where appropriate. Monitor and direct defense counsel, independent adjusters, and experts.
• Identify claims with potential exposure in excess of authority and advise their Supervisor/Manager
• Evaluate, set, or recommend reserves for each file they are handling.
• Prepare written reports as dictated by company policy and procedures.
• Handle claims within guidelines of the Fair Claims Practices 790.03
• Provide insureds, claimants, underwriters, and carriers with regular updates on status of file handling.
• Discuss unique and complex files with Supervisor/Manager

Skills

Complex Allied Health claims

Litigation management

MS Office

Adjusting license

Education

College degree or equivalent

Tools

Microsoft Outlook

Word

Excel

Job description

Integrated Specialty Coverages, LLC (ISC) is seeking a Complex Loss Specialist focused on Allied Health claims. The role involves adjusting high-exposure losses, presenting analyses to Senior Executives, and leading roundtable discussions to determine optimal resolution strategies.

You will review medical records, draft reservation of rights, manage litigation, and coordinate with defense counsel and experts across nationwide programs, with authority varying by carrier.