Senior Healthcare Claims Examiner - Impact & Growth

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

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.