Complex Claims Specialist

HICIX Hiscox Insurance Company Inc.; New York (NY); Hybrid; USD 125,000 - 155,000; Full time

Benefits offered by this job

Competitive salary and bonus

401(k) with company matching

Health insurance

Paid time off

Job summary

Hiscox USA in the United States seeks a Complex Claims Specialist - Allied Healthcare to manage mid-to high-severity professional liability claims from inception to resolution, including mental health, social services, medical spas, home health and related partners. This is a hands-on, individual contributor role with limited supervision.

The role requires 6+ years in professional liability or medical malpractice claims, strong negotiation and litigation leadership, and an ABA JD or BA/BS as

Qualifications

• 6+ years of Professional Liability or Medical Malpractice claims handling experience.
• BA/BS degree required; JD from ABA-accredited school may supplement claims handling experience.
• Proven ability to positively affect complex claims outcomes through investigation, negotiation and leading litigation.
• Ability to work in a fast-paced and changing environment.
• Advanced knowledge of coverage within specialty.
• Advanced knowledge of litigation process and negotiation skills.
• Experience mentoring and training other claims examiners.
• Excellent verbal and written communication skills.
• Adjuster licensing is required within 90 days of employment.

Responsibilities

• Adjusts and resolves complex mid-to-high severity claims with minimal supervision.
• Drafts complex coverage letters, including reservation of rights and denial letters.
• Reviews and analyzes claim documentation and legal filings.
• Drives litigation best practices to lead defense strategy on litigated files.
• Mentors team members and shares expertise.
• Identifies emerging exposures and claims trends.
• Identifies suspected fraudulent claims and coordinates with SIU.
• Accurately documents claim files with all relevant materials in compliance with policies and regulations.

Skills

Claims handling

Negotiation

Litigation leadership

Mentoring

Communication

Adaptability

Licensing

6+ years claims experience

Education

BA/BS required, JD preferred

Job description

Job Type: Permanent Build a brilliant future with Hiscox Our Complex Claims Specialist - Allied Healthcare is an individual contributor role, responsible for the handling of mid to high-severity primary Allied Healthcare Professional Liability claims from inception to resolution. This includes, but is not limited to, mental health counseling practices, social services, medical spas, home health aid and healthcare staffing agencies, pharmacies and testing laboratories. The role is responsible for all aspects of the claims and litigation process, including liaising with external and internal business partners (e.g., outside experts and/or legal counsel; underwriting) as required.

The Role

• Adjusts and resolves complex mid to severity claims that include all phases of litigation With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters
• Reviews and provides analysis of claim documentation and legal filings
• Drives litigation best practices to lead defense strategy on litigated files
• Mentors team members
• Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions
• Identifies emerging exposures and claims trends
• Identifies suspected fraudulent claims and tracks with special investigations unit
• Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities

The Team

The US Claims team at Hiscox is a growing group of professionals working together to provide superior customer service and claims handling expertise. The claims staff are empowered to manage their claims within given authority to provide fair and fast resolution of claims for our insured and broker partners. With strong growth across the US business, the Claims team is focused on delivering profitability while reinforcing Hiscox’s strong brand built on a long history of outstanding claims handling.

Requirements

• 6+ years of Professional Liability and/ or Medical Malpractice lines claims handling experience.
• B.A./B.S Degree required, JD optimal JD from an ABA accredited law school may be considered as a supplement to claims handling experience.
• Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation.
• Ability to work in a fast-paced and changing environment.
• Advanced knowledge of coverage within the team’s specialty or focus.
• Advanced knowledge of litigation process and negotiation skills.
• Experience in mentoring and training other claims examiners.
• Excellent verbal and written communication skills.
• Advanced analytical skills.
• Adjuster licensing is required within 90 days of employment.

Additional Factors Considered

• Demonstrates ability to work with minimal oversight.
• Demonstrates ability to advance product innovation or develop a greater understanding of other aspects of the business through training or other relevant projects across teams of lines of business.
• Demonstrates courage and confidence in addressing and solving difficult or severity matters with insureds, attorneys, and brokers.
• Experience attending and leading mediations, arbitrations and trials.
• Demonstrates courage in addressing and solving difficult or complex matters with insureds, attorneys and brokers.

What Hiscox USA offers

• Competitive salary and bonus (based on personal & company performance)
• 401(k) with competitive company matching
• Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)
• Company paid group term life, short-term disability and long-term disability coverage
• 24 Paid time off days, 2 Hiscox Days, 10 paid holidays, and ability to purchase 5 PTO days
• Paid parental leave
• 4 week paid sabbatical after every 5 years of service
• Financial Adoption Assistance and Medical Travel Reimbursement Programs
• Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
• Recipient of 2024 Cigna’s Well-Being Award for having a best-in‑class health and wellness program

Salary Range: $125,000-$155,000

The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

**Please note that this position is hybrid and requires two (2) days in our office weekly**

About Hiscox USA

Hiscox USA was established in 2006 to focus primarily on the needs of small and middle market commercial clients, via both the broker and direct distribution channels and is today the fastest-growing business unit within the Hiscox Group. Hiscox USA offers a broad portfolio of commercial products, including technology, cyber & data risk, multiple professional liability lines, media, entertainment, management liability, crime, kidnap & ransom, commercial property and terrorism. You can follow Hiscox on LinkedIn, Glassdoor and Instagram (@HiscoxInsurance) #LI-RM1

Dynamic, creative and values-driven culture

Modern and open office spaces, complimentary drinks

Work with amazing people and be part of a unique culture

If you want to help build a brilliant future; work with amazing people; be part of a unique company culture; and, of course, enjoy great employee benefits that take care of your mental and physical wellbeing, come and join us.

We’re a global, specialist insurer headquartered in Bermuda and listed on the London Stock Exchange. With 3,000 employees and 32 offices in 12 countries we’re a business with lots of opportunity for people with talent, spark and lots of ambition. If you want to build a great career with a company that prioritises strong values – such as integrity and courage – where our people always pull together to do the right thing for each other and our customers, then we’d love to hear from you.