Complex Loss Specialist (Allied Health)

Remote; San Francisco (CA); Remote; USD 120,000 - 190,000; Full time

Job summary

Integrated Specialty Coverages, LLC (ISC) is building a digitally focused team to redefine how brokers and agents source insureds. The Complex Loss Specialist for Allied Health will adjust high-exposure, time-intensive claims, providing analysis and executive-level presentations while leading strategic discussions.

This role requires a minimum of 10 years in claims, a home-state adjusting license, and strong proficiency with MS Outlook, Word, and Excel.

Qualifications

• Minimum of 10 years of claims experience, with emphasis on complex Allied Health claims.
• College degree or equivalent claims management experience.
• 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

• Adjust and settle complex Allied Health claims.
• Coordinate with underwriters, agents, and defense counsel.
• Perform coverage analysis and reserve evaluation.
• Prepare roundtable summaries and written reports.
• Direct defense counsel and experts.
• Maintain detailed claim file documentation.
• Communicate status updates to insureds and carriers.

Skills

Complex claims handling

Litigation management

Excellent communication

Analytical thinking

Education

College degree or equivalent

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

Defining the future of work & living globally

Integrated Specialty Coverages, LLC (ISC) is a growth stage technology and data-driven commercial MGA and insurance wholesaler leading innovation in the market.

Backed by one of the leading private equity firms, Onex Partners, and led by a forward-thinking management team, ISC is combining the worlds of insurance and technology to create an Insurtech powerhouse. As a leading online distributor of insurance products for a range of industries and “Main Street USA”, we are looking for the right people to help us in our mission of achieving exponential growth. We strive to be the number one place to go for brokers and agents to source insurance. To accomplish this, we’re building a digitally focused team that deeply understands the intersection between user experience, data, and AI/ML to optimize the way we engage with our customers and partners.

Job Summary

The Complex Loss Specialist position at Golden State Claims Services reports to a Claims Supervisor or Claims Manager and will specialize in Allied Health claims. The chief duty of the Complex Loss Specialist for Allied Health claims is to adjust the most time-intensive, complex, and high exposure losses that require a higher level of technical expertise, knowledge, and negotiating ability, for the program(s) to which is assigned. The Complex Loss Specialist will have a high level of ability to provide analysis and presentations to Senior Executives and Program Executives for these complex matters and will be well-versed in leading strategic roundtable discussions to determine optimal resolution strategy.

Position 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

Core Technical Duties

Healthcare liability claims investigation and evaluation, including medical malpractice, general liability, and professional liability exposures

Coverage analysis and interpretation of allied health professional liability policies, including review of coverage dates, limits, exclusions, and endorsements

Medical record review and interpretation across allied health disciplines (physical therapy, home health, diagnostics, behavioral health, etc.)

Drafting reservation of rights letters and coverage denial communications for supervisor review

Reserve evaluation, setting, and recommendation based on exposure analysis and claim trajectory

Litigation management, including assignment and direction of defense counsel, independent medical examiners, and expert witnesses

Securing recorded and written statements from insureds, claimants, and witnesses

Gathering and organizing supporting documentation including incident reports, medical records, licensing records, contracts, and expert reports

Maintaining accurate, detailed claim file documentation in compliance with carrier and program guidelines

Preparing written reports and roundtable summaries consistent with company policies and procedures

Minimum 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