Senior Complex Claims Specialist – Allied Healthcare

Hiscox

. Handle mostly high-severity primary Allied Healthcare Professional Liability claims from inception to resolution .

Posted 10/23/2026full-timeUnited StatesSenior💰 $140,000 - $170,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Expertise in managing high-severity Allied Healthcare Professional Liability claims, with a strong focus on litigation processes, negotiation, and mentoring. Proven ability to drive positive outcomes through investigation and strategic claim management.

Highest-signal resume keywords

Professional Liability Claims HandlingMedical Malpractice ExperienceAdvanced Litigation KnowledgeAdjuster LicensingMentoring and Training Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ManagementLitigation ProcessCoverage AnalysisNegotiation SkillsFraud DetectionTechnical LeadershipFile DocumentationClaims Strategy ManagementAlternative Dispute ResolutionAnalytical Skills

Soft Skills

Excellent Communication SkillsAbility to Work IndependentlyCourage in Problem SolvingAdaptability in Fast-Paced Environments

Certifications & Qualifications

B.A./B.S DegreeJD from ABA Accredited Law SchoolAdjuster Licensing

Industry Keywords

Allied HealthcareMental Health CounselingSocial ServicesHealthcare StaffingMedical SpasPharmaciesTesting LaboratoriesClaims TrendsFraudulent ClaimsDefense Counsel Management

About the role

Key responsibilities & impact

Handle mostly high-severity primary Allied Healthcare Professional Liability claims from inception to resolution
Handle claims involving mental health counseling practices, social services, medical spas, home health aid and healthcare staffing agencies, pharmacies and testing laboratories
Manage all aspects of the claims and litigation process
Liaise with external and internal business partners, including outside experts, legal counsel and underwriting
Act as subject matter expert within the team
Model gold standard for litigation best practices and file integrity
Identify and provide potential solutions for emerging exposures and claims trends
Identify suspected fraudulent claims and track them with the special investigations unit
Adjust the highest severity claims to resolution with minimal supervision
Draft complex technical coverage analyses and letters
Drive positive claim outcomes through investigation, negotiation and alternative dispute resolutions
Identify appropriate matters for trial
Accurately document claim files with relevant correspondence and notes in compliance
Mentor and train other claims examiners
Manage defense counsel and claim strategy

Requirements

What you’ll need

10+ years of Professional Liability and/or Medical Malpractice liability handling experience
B.A./B.S Degree required
JD optimal
JD from an ABA accredited law school may be considered as a supplement to claims handling experience
Adjuster licensing is required within 90 days of employment
Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation
Ability to work in a fast-paced and changing environment
Advanced knowledge of coverage within the team’s specialty or focus
Advanced knowledge of litigation process and negotiation skills
Experience in mentoring and training other claims examiners
Excellent verbal and written communication skills
Advanced analytical skills
Proven ability to positively affect highest severity claims outcomes through investigation, negotiation and effectively leading litigation and managing defense counsel and claim strategy
Subject matter expertise or technical leadership in other lines of business and/or claim types
Demonstrates ability to work with minimal oversight
Demonstrates ability to advance product innovation or develop a greater understanding of other aspects of the business through training or other relevant projects across teams of lines of business
Demonstrates courage and confidence in addressing and solving difficult or severity matters with insureds, attorneys, and brokers

Benefits

Comp & perks

Competitive salary and bonus (based on personal & company performance)
401(k) with competitive company matching
Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)
Company paid group term life, short-term disability and long-term disability coverage
24 Paid time off days, 2 Hiscox Days, 10 paid holidays, and ability to purchase 5 PTO days
Paid parental leave
4 week paid sabbatical after every 5 years of service
Financial Adoption Assistance and Medical Travel Reimbursement Programs
Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
Best-in-class health and wellness program
Modern and open office spaces, complimentary drinks