Senior Claims Specialist, HMO & PEI Claims

Liberty Mutual Fire Insurance Co.; Boston (MA); On-site; USD 83,000 - 157,000; Full time

Job summary

Liberty Mutual Fire Insurance Co. in the US is seeking a Senior Claims Specialist for HMO and PEI claims, handling a book from investigation through settlement.

You will evaluate coverage, document claims, and manage reserves within authority limits while coordinating with management and underwriting. The role requires 5+ years in claims handling, strong negotiation and communication skills, and licensure maintenance.

Qualifications

• Bachelor's degree required; advanced degree preferred.
• 5+ years of experience in claims handling, legal, or a related field.
• Strong working knowledge of claims handling concepts, practices, and techniques.
• Solid understanding of insurance law and regulations across multiple jurisdictions.
• Excellent verbal and written communication skills.
• Strong negotiation skills, with the ability to resolve claims effectively within authority limits.
• Experience handling HMO and Provider Excess Claims (preferred).

Responsibilities

• Analyzes, investigates, and evaluates losses to determine coverage and appropriate claim disposition.
• Documents claims and sets diaries for follow-up and key events using CMS.
• Establishes indemnity and expense reserves within settlement authority, reviewing adequacy; recommends reserve levels.
• Prepares comprehensive claim reports as required.
• Identifies emerging claim trends and issues; communicates findings to management and underwriting.
• Manages the litigation process, including retaining counsel and overseeing case resolution.
• Ensures adherence to line-of-business litigation guidelines, budgets, bill review, and payments.
• Participates in mediations/arbitrations within assigned settlement authority.
• Participates in the claims audit process.
• May support claims marketing by engaging with brokers, risk managers, and reinsurers.
• Maintains required insurance adjuster licenses.

Skills

Claims handling

Negotiation

Verbal communication

Written communication

Investigative skills

Education

Bachelor's degree

Advanced degree preferred

Tools

CMS (claims management system)

Job description

Senior Claims Specialist, HMO & PEI Claims

Job Locations: US-CT-Weatogue | US-Remote | US-MA-Boston | US-NY-New York

Job ID: 2026-261979

Position Type: Full-Time

Job Grade: 15

Department: 090H-12314 HMO Re/PEI

Market: Global Risk Solutions

Minimum Salary: USD $83,000.00/Yr.

Maximum Salary: USD $157,000.00/Yr.

Travel: 10%

Description

Working under moderate direction, this role manages a book of specialty lines claims across the full claim lifecycle — from initial investigation through settlement and closure. The Claims Specialist conducts thorough investigations, recommends appropriate reserves, and resolves claims efficiently and cost-effectively within established authority limits for the line of business.

Responsibilities:

• Analyzes, investigates, and evaluates losses to determine coverage and appropriate claim disposition
• Documents claims and sets diaries for follow-up and key events using CMS
• Establishes appropriate indemnity and expense reserves within assigned settlement authority, reviewing regularly to ensure adequacy; recommends reserve levels for claims exceeding authority
• Prepares comprehensive claim reports as required
• Identifies emerging claim trends and account or policy issues, communicating findings to management and underwriting
• Manages the litigation process, including retaining counsel and overseeing case resolution
• Ensures adherence to line-of-business litigation guidelines, including budget management, bill review, and payment
• Actively participates in mediations and arbitrations within assigned settlement authority
• Participates in the claims audit process
• May support claims marketing efforts by engaging with brokers, risk managers, and reinsurers
• Maintains required insurance adjuster licenses

If the selected candidate lives within 50 miles of a GRS office, then the selected candidate must come into the office two days/month.

Qualifications

Qualifications:

• Bachelor's degree required; advanced degree preferred
• 5+ years of experience in claims handling, legal, or a related field
• Strong working knowledge of claims handling concepts, practices, and techniques, including coverage issues and product line expertise
• Solid understanding of insurance law and regulations across multiple jurisdictions
• Excellent verbal and written communication skills
• Strong negotiation skills, with the ability to resolve claims effectively within authority limits

Preferred Qualifications:

• Experience handling HMO and Provider Excess Claims