Lead Medical Claims Specialist, HPL — Hybrid

Tokio Marine HCC – A&H Group; 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

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.