Lead Claims Specialist, HPL

HCC Service Company, Inc.; Alpharetta (GA); Hybrid; USD 95,000 - 125,000; Full time

Benefits offered by this job

Competitive salary and benefits

401(k) plan with company match

Paid time off and holidays

Learning culture and development

Job summary

Tokio Marine HCC – A&H Group in Alpharetta is seeking a Lead Claims Specialist for hospital professional liability and general liability claims. You will assess coverage, liabilities, and damages, and negotiate settlements for the Excess Healthcare line.

The role requires a bachelor’s degree, a state adjusting license, and 6+ years of medical professional liability experience across the United States. Strong communication and MS Office proficiency are essential.

Qualifications

• Bachelor’s degree in business administration, risk management and/or insurance.
• State Adjusting Licenses required.
• 6 years of relevant and progressive experience in handling medical professional liability claims across the United States.
• Excellent communication, analytical and problem-solving abilities.
• Proficient in Microsoft Office (Excel, Access, PowerPoint, Word).

Responsibilities

• Oversee all aspects of claims to minimize company risk of loss.
• Analyze and draft coverage letters and communicate positions to insureds, brokers and agents.
• Conduct proactive claim investigations and maintain a diary of files.
• Set timely reserves and draft reports to leadership.
• Direct outside counsel and vendors as needed.
• Negotiate claim settlements and attend court hearings (mediations, conferences, trials).
• Complete all required regulatory reporting.
• Mentor and educate less experienced adjusters.
• Represent TMHCC at industry conferences as needed.
• Develop claims systems and processes.
• Plan work, set timelines and allocate resources to meet deadlines.
• Ensure cost-efficient operations and adherence to policies.

Skills

Communication skills

Analytical skills

Problem-solving

MS Office

Education

Bachelor's degree in business administration/risk management/insurance

Job description

Role Details

Job Title: Lead Claims Specialist, HPL
Location: 4:1 Hybrid (Alpharetta or Kennesaw office)
Reports To: Head of Excess & Healthcare Claims
Employment Type: FTE

About Us

Help us insure it. Tokio Marine HCC is a leading global specialty insurance group, backed by the strength and stability of the Tokio Marine Group. With more than 50 years of sustained growth and profitability, and offices across the United States, the United Kingdom, Europe, and other international locations, we offer more than 100 classes of specialty insurance—covering everything from the crops that feed us and the concerts that entertain us to rescuing travelers abroad. Guided by our Mind Over Risk philosophy, we empower clients to pursue opportunities with confidence while fostering a culture rooted in innovation, collaboration, and trust. Always Advancing, we embrace an entrepreneurial spirit; as Experts in Tomorrow, we anticipate what’s next; and by Reaching Out, we build genuine connections that enable our people and our business to thrive.

Role Overview

Manage hospital professional liability, general liability, auto, and managed Care claims that involve the investigation of coverage, evaluation of liability and damages, and resolution, including but not limited to negotiation of settlements for the Excess Healthcare line of business.

Key Responsibilities

• Proactively oversee all aspects of claims to minimize company risk of loss.
• Analyze and draft coverage letters while properly communicating coverage positions to insureds, brokers and agents.
• Conduct proactive claim investigations and maintain a diary applying best practices to all files.
• Set timely reserves and draft concise reports to leadership when authority is exceeded.
• Assign, direct, and closely monitor outside counsel and vendors as needed.
• Negotiate claim settlements and attend court hearings, including mediations, settlement conferences, and trials.
• Complete all required regulatory reporting.
• Mentor and educate less experienced adjusters.
• Represent TMHCC at industry conferences as necessary to establish TMHCC as a market thought leader.
• Conduct insured audits, loss runs reviews and produce reports to senior leadership.
• Aide in the development of claims systems and processes.
• Planning: Develop work plans, establish timelines, and set goals for assigned work and work unit; assign resources as needed; meet commitments on deadlines.
• Communication: Communicate team or work unit results and recommendations with management and clients as appropriate.
• Cost Management: Drive improvement in existing business processes and assist in the implementation of new processes; ensure unit performs work thoroughly in a cost-efficient manner and at a high productivity level.
• Business Controls and Policies: Comply with all corporate policies and procedures; report any breakdown in controls to management; conduct all activities in a safe manner; ensure all the above are followed within assigned work unit.
• People Management: Plan, conduct, and supervise assignments; train assigned personnel and assign work; may assist with the review and evaluation of assigned personnel.

What You Bring

• Bachelor’s degree in business administration, risk management and/or insurance.
• State Adjusting Licenses required.
• 6 years of relevant and progressive experience in handling medical professional liability claims throughout the United States.
• Knows the most effective and efficient methods to get things done, with a focus on continuous improvement and innovation.
• Sound analytical skills, as well as strong decision-making and problem-solving aptitude.
• Must be an exceptional communicator and able to make connections externally and internally.
• Flexibility and a willingness to learn and adapt to new developing processes, systems, and procedures.
• Excellent written and verbal communications skills with an emphasis on confidentiality, tact, and diplomacy.
• Intermediate to advanced proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word).

Travel (if required/needed) Regular travel (up to 50% of time) Passport Required: No Driver’s License Required: No

What We Offer

• Competitive salary and comprehensive medical, vision, and dental benefit package, with eligibility beginning on your date of hire
• Strong learning culture with ongoing development opportunities
• Basic life and disability insurance
• 401(k) plan with 6% company match
• 20 days of PTO, two floating holidays, approximately 11 paid holidays, and volunteer time off
• Paid parental leave
• An opportunity to do meaningful work and love what you do

Equal Opportunity Employer TMHCC is an equal opportunity employer.

All qualified applicants will receive consideration for employment without regard to age, ancestry, citizenship, color, family or medical care leave, gender identity, genetic information, marital status, medical condition, national origin, physical or mental disability, protected veteran or military status, race, ethnicity, religion, sex (including pregnancy), sexual orientation, or any other characteristic protected by applicable local laws, regulations, and ordinances.

Your success is our priority. In a world that is rapidly changing, TMHCC enables you to take on opportunities with confidence. At Tokio Marine HCC, we pride ourselves on hiring the smartest, most conscientious people, who want to make a difference no matter their background. And then we give them the support and trust they need. We’re always looking for curious, creative transformative thinkers who want to change the status quo and have a passion for doing the right thing. If this is you, then we want you on our team.