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Claims Examiner – Commercial Healthcare
Core Specialty Insurance Holdings, Inc.. Handle Commercial Healthcare Claims across the U.S.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in handling Commercial Healthcare Claims, ensuring compliance with guidelines, and managing complex claims portfolios. Proficient in negotiation, communication, and maintaining relationships with insureds, agents, and brokers while adhering to legal and regulatory standards.
Highest-signal resume keywords
Claims AdjustingHealthcare Professional LiabilityNegotiation SkillsRegulatory ComplianceClaims Portfolio Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims EvaluationALAE ManagementReserving ProtocolsMediation ParticipationReinsurance HandlingMedical TerminologyState and Federal LawsPolicy Language UnderstandingClaims ReportingClaims Investigation
Soft Skills
Strong Communication SkillsDetail OrientedOrganizational SkillsProblem Solving SkillsTeam Collaboration
Certifications & Qualifications
Claims Adjuster License
Industry Keywords
Commercial Healthcare ClaimsExcess CasualtyPrimary CasualtyLitigation ManagementPanel Counsel ProgramContinuing EducationClaims Handling GuidelinesLarge Loss ReportsHealthcare Industry
About the role
Key responsibilities & impact- Handle Commercial Healthcare Claims across the U.S.
- Ensure compliance with claim handling guidelines covering coverage, investigation, liability, damages, evaluation, and resolution
- Oversee claims portfolios within the primary casualty book and maintain contact with insureds, agents, and brokers
- Oversee claims portfolios handled by TPAs within the excess casualty book
- Control and manage ALAE by selecting, instructing, and managing third-party vendors
- Gather and analyze information to evaluate claims, 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 participate substantially in mediation negotiations
- Adhere to the Panel Counsel Program and Litigation Management Guidelines
- Complete reporting requirements, including Large Loss Reports, accurately and on time
- 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 when 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 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
- Minimum of 3 years of claims adjusting or legal experience required
- Background in US Healthcare Professional/General Liability preferred
- Prior employment as a Healthcare professional or Medical Malpractice attorney is a plus
- Experience handling Primary and Excess claims
- Additional experience handling Reinsurance 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 all 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.
- Sponsorship is not available now or in the future for this position
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