Complex Claims Specialist

EmPRO Insurance Company; Village of Roslyn (NY); On-site; USD 90,000 - 120,000; Full time

Job summary

EmPRO Insurance Company is seeking a Complex Claims Specialist to handle complex medical liability claims with a strong client service focus. The role is on-site in Roslyn, NY, Rochester, NY, or Hamilton, NJ, with a hybrid option after training.

You will follow standard claims protocols, manage client relationships, investigate exposures, set reserves, and lead negotiations, trials, and mediations, mentoring staff and ensuring data integrity.

Qualifications

• Bachelor’s degree or JD required.
• Six years of claims handling experience required; medical professional liability preferred.
• Must obtain NY adjuster license within 6–12 months.
• Strong analytical and problem-solving skills with attention to detail.
• Excellent written and verbal communication skills.
• Ability to work independently and mentor others.
• On-site work required; travel may be necessary.

Responsibilities

• Follow standard claims protocols for documentation, coverage verification and file management.
• Maintain organized claims files and suggest improvements as needed.
• Manage significant client relationships for claims department; collaborate with underwriting on marketing.
• Investigate significant exposures and set appropriate indemnity and expense reserves.
• Develop resolution strategies and lead negotiations to bring matters to a close.
• Attend trials and mediations when necessary; guide and support less experienced staff.
• Ensure data integrity and oversee defense counsel; coordinate litigation strategy.
• Proactive communication with insureds, other departments and claim leadership.

Skills

Client relationship management

Analytical reasoning

Leadership/mentoring

Documentation

Oral and written communication

Education

Bachelor’s degree or JD

Job description

Location & Schedule

This role is onsite at our Roslyn, NY, Rochester, NY, or Hamilton, NJ office, with the option for a hybrid schedule after the training period.

General Summary

A Complex Claims Specialist will possess experience in handling complex medical liability claims, while demonstrating a strong client service focus.

Essential Duties & Responsibilities

• Follow standard claims protocols for documentation, coverage verification, and file management
• Maintain accurate and organized claims files, suggesting improvements as necessary.
• Manage significant client relationships for claims department, collaborate with underwriting on marketing.
• Investigate and document most significant exposures, setting appropriate indemnity and expense reserves
• Develop resolutions strategy and lead negotiations and bring matters to a close
• Attend trials and mediations when necessary
• Adhere to industry Best Practices for effective claim management
• Mentor staff through formal and informal training and development; demonstrate extensive technical expertise to guide and support less experienced claims professionals
• Ensure exceptional data integrity
• Actively manage defense council and partner on litigation strategy
• Proactive communication with insureds, other departments and claim leadership
• Perform additional duties and responsibilities as assigned

Education & Qualifications

• Bachelor’s degree or JD required
• Six years’ claims handling experience required; medical professional liability strongly preferred
• NY adjusters license required within the first 6 - 12 months of employment
• Strong analytical and problem-solving skills with attention to detail
• Demonstrate solid and concise business writing proficiency
• Exhibit strong oral communication skills to include presenting information clearly and effectively to diverse audiences
• Ability to work independently as well as assume a mentorship role within a team. Act as a strong example and resource for less experienced colleagues
• Strong ethical judgement and a commitment to maintaining confidentiality
• Must be able to work on site
• Travel required as needed; may include overnight travel

Compensation

The actual compensation for this position will be determined by experience and other factors permitted by law.