Remote Healthcare Claims Examiner - Complex Losses

corespecialtyinsurance; Atlanta (GA); Hybrid; USD 70,000 - 95,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Short/Long-term Disability

401(k) Company-match

Employee Assistance Plan

Health Savings Account

Flexible Spending Account

Health Reimbursement Account

Wellness Program

Job summary

Core Specialty Insurance is seeking a Healthcare Claims Examiner to handle Commercial Healthcare Claims across the U.S. You will oversee claims portfolios, liaise with insureds, agents, and brokers, and manage third-party vendor relationships.

The role requires a college degree or equivalent, active claims adjuster licensing, and 3+ years of claims adjusting or legal experience, preferably in healthcare or general liability. Travel to mediations/trials may be required.

Qualifications

• College degree required or equivalent experience.
• Must be licensed as a claims adjuster in home state; multi-state licensure preferred.
• A minimum of 3 years of claims adjusting or legal experience required; healthcare liability preferred.
• Healthcare professional or Medical Malpractice attorney background is a plus.
• Experience handling Primary and Excess claims; reinsurance experience preferred.
• Willingness to travel for meetings, mediations, and trials.

Responsibilities

• Handle Commercial Healthcare Claims across the U.S. in accordance with guidelines.
• Maintain contact with insureds, agents, and brokers over claim portfolios.
• Oversee claims portfolios managed by TPAs within excess casualty book.
• Conduct ALAE control and manage 3rd party vendors as needed.
• Gather information to evaluate claims and decide within authority; identify settlements.

Skills

Negotiation

Communication

Writing

Problem solving

Detail oriented

Team player

Self-starter

Independence

Education

College degree or equivalent

Job description

Core Specialty Insurance is seeking a Healthcare Claims Examiner to handle Commercial Healthcare Claims across the U.S. You will oversee claims portfolios, liaise with insureds, agents, and brokers, and manage third-party vendor relationships.

The role requires a college degree or equivalent, active claims adjuster licensing, and 3+ years of claims adjusting or legal experience, preferably in healthcare or general liability. Travel to mediations/trials may be required.