Healthcare Claims Examiner – Complex Claims & Mediation

Core Specialty Insurance Holdings, Inc.; Dallas (TX); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical, dental, vision, and life ins.

Disability insurance (short & long)

401(k) with company match

Employee Assistance Plan

Health Savings / Flexible Spending / H

Job summary

Core Specialty Insurance Holdings, Inc. seeks an experienced Healthcare Claims Examiner to manage Commercial Healthcare Claims across the U.S.

The role requires strong negotiation and writing skills, a valid claims adjuster license in the home state, and the ability to handle primary and excess claims with rigor. Responsibilities include overseeing claims portfolios, coordinating with insureds, agents, and brokers, and ensuring compliance with guidelines while potentially engaging in mediations

Qualifications

• College degree required or equivalent experience.
• Must be licensed as a claims adjuster in home state; multi-state licensure preferred.
• Minimum 3 years of claims adjusting or legal experience; US Healthcare Professional/General Liability preferred.
• Prior history as healthcare professional or medical malpractice attorney is a plus.
• Experience handling Primary and Excess claims; reinsurance experience preferred.
• Ability to travel for meetings, mediations and trials as required.
• Strong negotiation, communication and writing skills.
• Must be detail oriented and organized; able to work independently and as part of a team.
• Self-starter with problem solving abilities; manage pending caseloads and deadlines.

Responsibilities

• Ensure compliance with claim handling guidelines across coverage, investigation, liability, damages, evaluation and resolution.
• Oversee claims portfolios within primary casualty; maintain contact with insureds, agents and brokers.
• Oversee TPAs in excess casualty book; manage ALAE with 3rd party vendors as needed.
• Gather information to prepare accurate claim evaluations and determine settlements within authority.
• Establish reserves per reserving protocols and procedures.
• Proactively resolve complex/high-exposure claims; participate in mediations as needed.
• Adhere to Litigation Management Guidelines and Panel Counsel Program.
• Meet reporting requirements including Large Loss Reports; coordinate with underwriting on trends.
• Occasional domestic travel for mediations/trials; perform general office duties as required.
• Stay informed on market developments and continue education opportunities.

Skills

Strong communication and writing

Detail oriented

Independently work well

Self-starter and problem solving

Ability to manage caseloads

Education

College degree

Job description

Core Specialty Insurance Holdings, Inc. seeks an experienced Healthcare Claims Examiner to manage Commercial Healthcare Claims across the U.S.

The role requires strong negotiation and writing skills, a valid claims adjuster license in the home state, and the ability to handle primary and excess claims with rigor. Responsibilities include overseeing claims portfolios, coordinating with insureds, agents, and brokers, and ensuring compliance with guidelines while potentially engaging in mediations