Lead Claims Specialist, HPL

Tokio Marine HCC International; Alpharetta (GA); Hybrid; USD 90,000 - 130,000; Full time

Benefits offered by this job

401(k) plan with 6% company match

PTO + holidays and volunteer time off

Parental leave

Job summary

Tokio Marine HCC International is seeking a Lead Claims Specialist, HPL, in a 4:1 hybrid role based in Alpharetta or Kennesaw. You will manage hospital professional liability, general liability, auto, and managed care claims, guiding investigations, evaluating liability, and negotiating settlements for the Excess Healthcare line.

You will mentor junior adjusters, draft coverage positions, set reserves, and coordinate with outside counsel. Regular travel up to 50% may be required.

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.
• Strong communication and analytical abilities.
• Ability to work with cross-functional teams and manage details.

Responsibilities

• Oversee all aspects of hospital professional liability, general liability, auto, and managed care claims.
• Investigate coverage, evaluate liability and damages, and negotiate settlements.
• Draft coverage letters and communicate coverage positions clearly to insureds and brokers.
• Set reserves and prepare leadership reports when authority is exceeded.
• Mentor less experienced adjusters and support professionals.
• Represent the company at industry conferences when needed.
• Ensure regulatory reporting and compliance across units.

Skills

Communication

Analytical skills

Problem-solving

MS Office proficiency

Education

Bachelor's degree in business administration, risk management and/or insurance

State Adjusting Licenses required

Tools

MS Office

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 usinsureit.

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 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.

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