Remote Healthcare Claims Lead (Complex & High-Exposure)

Core Specialty Insurance Holdings, Inc.; Atlanta (GA); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical, dental, vision, and life ins.

Short and long-term disability

401(k) Company match (6%)

Job summary

Core Specialty Insurance Holdings, Inc. is seeking a Healthcare Claims Examiner to directly handle Commercial Healthcare Claims across the United States. The role requires licensing and 3+ years of claims or legal experience, with preference for US Healthcare/Liability background.

The position involves overseeing claim portfolios, managing third-party vendors, and ensuring timely reserves and resolutions. Occasional travel for mediations and trials is expected.

Qualifications

• Requires college degree or equivalent experience.
• Licensed as a claims adjuster in home state; multi-state licensure preferred.
• 3+ years of claims adjusting or legal experience required; healthcare liability preferred.

Responsibilities

• Handle Commercial Healthcare Claims across the U.S. with adherence to guidelines.
• Oversee claim portfolios in primary casualty book; maintain contact with insureds, agents and brokers.
• Oversee TPAs' claims in excess casualty book; manage 3rd party vendors for ALAE control.
• Gather information to evaluate claims and resolve within authority; identify settlement issues.
• Establish reserves per protocols; manage mediations and complex/high-exposure claims.
• Attend meetings with underwriting on trends; travel for mediations/trials as needed.
• Support reporting, continuing education, and other duties as required.

Skills

Claims adjusting

Legal experience

Communication skills

Writing skills

Time management

Independent work

Team player

Education

College degree

Job description

Core Specialty Insurance Holdings, Inc. is seeking a Healthcare Claims Examiner to directly handle Commercial Healthcare Claims across the United States. The role requires licensing and 3+ years of claims or legal experience, with preference for US Healthcare/Liability background.

The position involves overseeing claim portfolios, managing third-party vendors, and ensuring timely reserves and resolutions. Occasional travel for mediations and trials is expected.