Claims Examiner – Commercial Healthcare

Core Specialty Insurance Holdings, Inc.

. Handle Commercial Healthcare Claims, including Medical Malpractice and Healthcare facilities claims across the U.S.

Posted 11/4/2026full-timeUnited StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in handling Commercial Healthcare Claims, including Medical Malpractice and General Liability, while ensuring compliance with relevant guidelines and regulations. Proficient in claims evaluation, negotiation, and maintaining effective communication with stakeholders.

Highest-signal resume keywords

Claims AdjustingMedical MalpracticeHealthcare LiabilityNegotiation SkillsRegulatory Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims EvaluationALAE ManagementReserving ProtocolsMediation ParticipationReinsurance HandlingPolicy Language UnderstandingMedical TerminologyClaims Portfolio OversightLarge Loss ReportingThird-Party Vendor Management

Soft Skills

Strong Communication SkillsDetail OrientedOrganizational SkillsProblem Solving SkillsTeam Collaboration

Certifications & Qualifications

Claims Adjuster LicenseMulti-State Licensure

Industry Keywords

US Healthcare ClaimsExcess ClaimsPrimary ClaimsLitigation ManagementPanel Counsel Program

About the role

Key responsibilities & impact

Handle Commercial Healthcare Claims, including Medical Malpractice and Healthcare facilities claims across the U.S.
Ensure compliance with claim handling guidelines covering coverage, investigation, liability, damages, evaluation, and resolution
Provide oversight on claims portfolios within the primary casualty book and maintain contact with insureds, agents, and brokers
Provide oversight on claims portfolios handled by TPAs within the excess casualty book
Control and manage ALAE by selecting, instructing, and managing third-party vendors
Gather and analyse information to evaluate claims accurately, resolve claims, make decisions within authority levels, and identify settlement issues
Establish reserves according to reserving protocols and authority procedures
Resolve complex and/or high-exposure claims and limit company exposure
Participate substantially in mediation negotiations
Adhere to the Panel Counsel Program and Litigation Management Guidelines
Complete reporting requirements, including Large Loss Reports, accurately and timely
Liaise with underwriting regarding claim trends and other areas of interest
Work with external customers to answer questions, resolve problems, and maintain rapport
Attend mediations and/or trials; occasional domestic travel may be required
Undertake general office administrative duties as required
Maintain awareness of the current market/industry and attend continuing education programs when available
Undertake other duties as reasonably required by the Company

Requirements

What you’ll need

College degree required or equivalent experience
Must be licensed as a claims adjuster in their home state; multi-state licensure is preferred
A minimum of 3 years of claims adjusting or legal experience is required
Background in US Healthcare Professional/General Liability is preferred
Prior employment as a Healthcare professional or Medical Malpractice attorney is a plus
Experience handling Primary and Excess claims
Additional experience handling Reinsurance is preferred
Ability to travel for meetings, mediations and trials as required
Ability to negotiate and be persuasive
Strong communication and writing skills
Detail oriented and organized
Ability to work independently and as a team member
Self-starter with problem solving skills
Ability to manage pending caseloads, additional projects and meet deadlines set by management
General understanding and knowledge of state and federal laws as they apply to US Specialty Healthcare claims
General understanding of policy language/coverages applicable to US Specialty Healthcare
Understanding of medical terminology
Applicants must be authorized to work for any employer in the U.S.; the company cannot sponsor or take over work authorization sponsorship

Benefits

Comp & perks

Competitive salary
Opportunities for professional development and advancement
Medical insurance
Dental insurance
Vision insurance
Life insurance
Short-term disability
Long-term disability
Company-match of 100% of a 6% contribution 401(k) plan
Employee Assistance Plan
Health Savings Account
Flexible Spending Account
Health Reimbursement Account
Wellness program