Senior Claims Examiner, Healthcare

Berkshire Hathaway Specialty Insurance; Boston (MA); On-site; USD 120,000 - 150,000; Full time

Benefits offered by this job

Health, Dental and Vision benefits

Disability Insurance

Life Insurance

AD&D Insurance

Flexible Spending Accounts

Health Reimbursement Account

Employee Assistance Program

401(k) with Company Match

Paid Time Off

Tuition Reimbursement

Paid Parental Leave

Job summary

Berkshire Hathaway Specialty Insurance is seeking a Senior Claims Examiner, Healthcare, to handle and adjust Healthcare and Senior Care claims across primary, umbrella, and excess policies. You will work with insureds, brokers, TPAs, and defense counsel to deliver fair, timely outcomes.

The role requires 5–10+ years in healthcare claims, strong analytical abilities, and the capacity to manage complex matters with independent judgment.

Qualifications

• 5–10+ years of Healthcare claims handling experience or equivalent relevant experience.
• Strong technical knowledge and demonstrated capability in handling complex Healthcare claims.
• Experience evaluating coverage, liability, damages, reserves, and claim strategy across the lifecycle of a claim.
• Strong analytical and judgment skills with the ability to independently assess complex information and reach well-supported conclusions.
• Excellent interpersonal, written and verbal communication, and negotiation skills.
• Ability to work independently while collaborating effectively with insureds, brokers, TPAs, counsel, and internal teammates.
• Strong organizational skills with the ability to manage multiple complex matters and priorities simultaneously.

Responsibilities

• Manage and adjust Healthcare and Senior Care claims involving primary, umbrella, and excess policies while delivering a high level of customer service and maintaining strong technical claim file quality.
• Proactively manage claims from first notice of loss through resolution, partnering with insureds, brokers, TPAs, and internal stakeholders throughout the claims process.
• Analyze policy language and coverage issues, draft coverage correspondence as appropriate, and clearly communicate coverage positions.
• Lead and coordinate claim investigations, evaluating coverage, liability, damages, and overall exposure to support thoughtful and timely claim decisions.
• Direct and closely monitor assignments to experts and defense counsel, providing strategic guidance and maintaining appropriate oversight.
• Develop claim strategies, set reserves within delegated authority, and make recommendations regarding reserve changes based on evolving exposure.
• Prepare clear and timely claim reports and maintain accurate documentation throughout the life of the claim.
• Represent BHSI as appropriate at conferences, mediations, trials, and other claim-related proceedings.
• Collaborate across the Claims organization and with business partners to support effective outcomes for customers while maintaining BHSI’s standards for integrity, technical excellence, and thoughtful decision-making.

Skills

Healthcare claims

Complex claims

Coverage evaluation

Analytical judgment

Interpersonal skills

Independent work

Job description

Salary Range: $120,000.00 To $150,000.00 Annually

Who are we?

A strategic and trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI), provides a broad range of commercial property, casualty and specialty insurance coverages and outstanding service to customers and brokers around the world. Part of Berkshire Hathaway’s insurance operations, we bring our solutions to market with our stellar brand name, top-rated balance sheet, and the expertise of our global team of professionals, who exude excellent capabilities and strong character.

We are a values-based organization where respect, integrity, excellence, collaboration, and passion define who we are and how we do business. We value diversity of backgrounds, experience, and perspectives and strive to foster an inclusive environment that enables all our team members to bring their best selves to work. We are one team committed to building a culture where every teammate has the opportunity to contribute and be recognized. Want to be part of the team building the finest property, casualty, and specialty lines insurance company in the world?

At BHSI, our Claims professionals are an integral part of our business and our commitment to delivering outstanding service to customers and brokers. We are seeking an experienced professional to join our growing Healthcare Claims team in Chicago, Atlanta, Boston, or New York. This opportunity may be a strong fit for an experienced healthcare claims professional or a practicing attorney looking to transition from a law firm into the insurance industry.

As a Senior Claims Examiner, Healthcare, you will handle and adjust a range of Senior Care and Healthcare claims in a highly collaborative environment focused on thoughtful, responsive, and best-in-class claims handling. You will manage claims from first notice through resolution, evaluate complex coverage, liability, and damages issues, and work closely with insureds, brokers, TPAs, defense counsel, and internal partners.

This role provides the opportunity to apply strong technical and legal judgment while developing trusted relationships and helping deliver fair, timely, and effective claim outcomes.

Duties & Responsibilities:

• Manage and adjust Healthcare and Senior Care claims involving primary, umbrella, and excess policies while delivering a high level of customer service and maintaining strong technical claim file quality.
• Proactively manage claims from first notice of loss through resolution, partnering with insureds, brokers, TPAs, and internal stakeholders throughout the claims process.
• Analyze policy language and coverage issues, draft coverage correspondence as appropriate, and clearly communicate coverage positions.
• Lead and coordinate claim investigations, evaluating coverage, liability, damages, and overall exposure to support thoughtful and timely claim decisions.
• Direct and closely monitor assignments to experts and defense counsel, providing strategic guidance and maintaining appropriate oversight.
• Develop claim strategies, set reserves within delegated authority, and make recommendations regarding reserve changes based on evolving exposure.
• Prepare clear and timely claim reports and maintain accurate documentation throughout the life of the claim.
• Represent BHSI as appropriate at conferences, mediations, trials, and other claim-related proceedings.
• Collaborate across the Claims organization and with business partners to support effective outcomes for customers while maintaining BHSI’s standards for integrity, technical excellence, and thoughtful decision-making.

Qualifications, Skills and Experience:

• 5–10+ years of Healthcare claims handling experience or equivalent relevant experience.
• Strong technical knowledge and demonstrated capability in handling complex Healthcare claims.
• Experience evaluating coverage, liability, damages, reserves, and claim strategy across the lifecycle of a claim.
• Strong analytical and judgment skills with the ability to independently assess complex information and reach well-supported conclusions.
• Excellent interpersonal, written and verbal communication, and negotiation skills.
• Ability to work independently while collaborating effectively with insureds, brokers, TPAs, counsel, and internal teammates.
• Strong organizational skills with the ability to manage multiple complex matters and priorities simultaneously.
• Experience handling and adjusting claims across multiple jurisdictions.
• Must possess, or be willing and able to obtain, applicable claims licenses as required.

BHSI Offers:

• A competitive package and exciting growth opportunities for career-oriented teammates
• A dynamic, action oriented, and thoughtful environment centered on always doing the right thing for our customers, teammates, and our other stakeholders
• A purposely non-bureaucratic organization that embraces simplicity over complexity and emphasizes individual excellence in a team framework
• Benefits that support your life and well-being, which include:
  • Comprehensive Health, Dental and Vision benefits
  • Disability Insurance (both short-term and long-term)
  • Life Insurance (for you and your family)
  • Accidental Death & Dismemberment Insurance (for you and your family)
  • Flexible Spending Accounts
  • Health Reimbursement Account
  • Employee Assistance Program
  • Retirement Savings 401(k) Plan with Company Match
  • Generous holiday and Paid Time Off
  • Tuition Reimbursement
  • Paid Parental Leave

The base salary range for this position is from $120,000 – $150,000, along with annual bonus eligibility. Total compensation for a candidate is determined by their relevant skills, location, and experience. We value our teammates – both their capabilities and character – as demonstrated by our amazing culture.

NOTE: Compensation will be commensurate with experience. This job description is not intended to be all-inclusive. Team Member may perform other related duties as negotiated to meet the ongoing needs of the organization.