Sr. Claims Specialist, Healthcare

2 weeks ago

Alpharetta, United States Markel Full time
What part will you play? If you're looking for a place where you can make a meaningful difference, you've found it. The work we do at Markel gives people the confidence to move forward and seize opportunities, and you'll find your fit amongst our global community of optimists and problem-solvers. We're always pushing each other to go further because we believe that when we realize our potential, we can help others reach theirs.

Join us and play your part in something special

This position in Healthcare Claims will be responsible for the resolution of moderate to high complexity and moderate to high exposure claims which can be subject to disputes that must be resolved in mediation or litigation. The primary purpose of this job is to handle claims in the excess and reinsurance categories: from coverage enquiry through legal liability assessment (where relevant) and quantum analysis, to timely and accurate resolution; ensuring mitigation of indemnity and expense exposure while communicating developments and outcomes as necessary to all internal and external stakeholders. The position will have increased responsibility for decision making within their authority and work with minimal oversight and will provide training and be a technical referral point for other team members. College degree is required and a JD and/or minimum of 5 years claims handling experience is preferred.

Job Responsibilities
  • Confirms coverage of claims by reviewing policies and documents submitted in support of claims
  • Directs and monitors assignments to experts and outside counsel, ensures effective vendor and litigation management on moderate to high complexity claims including demonstrable savings
  • Analyzes coverage and communicates coverage positions
  • Prepare coverage position letters on matters typically in litigation without assistance of outside coverage counsel.
  • Utilizes acceptable investigation claims handling and settlement techniques that achieve cost effective and timely closure results by obtaining, reviewing and analyzing documentation, policy provisions and other records.
  • Conducts, coordinates, and directs investigation into loss facts and extent of damages
  • Provides timely service throughout the life cycle of the claim by meeting all service level agreements, initiating timely contact to all appropriate parties, and responding to incoming inquiries according to company policy and procedures.
  • Evaluates information on coverage, liability, and damages to determine the extent of insured's exposure
  • Sets reserves within authority or makes claim recommendations concerning reserve changes to manager
  • Negotiates and settles claims typically in litigation either directly or indirectly
  • Prepares reports by collecting and summarizing information
  • Present at roundtables to senior claims leaders and underwriters on cases going to trial
  • Participates in special projects or assists other team members as requested
  • Travel to mediations, trials, and conferences as required
  • Coordinates loss information for business stakeholders and presents information during meetings with underwriters and/or insureds when applicable
  • Contributes to maintenance of claims guidelines and best practice procedures
  • Delivers technical training to colleagues and external contacts as appropriate
Education
  • Bachelor's degree or equivalent work experience
  • JD , advanced degree, or focused technical degree a plus
Certification
  • Must have or be eligible to receive claims adjuster license.
  • Successful achievement of industry designations (INS, IEA, AIC, ARM, SCLA, CPCU) or
  • Participation in industry training opportunities (CLM Claim College, Munich Re Training, FDCC, etc.)
Work Experience
  • Minimum of 7-15 years of claims handling experience or equivalent combination of education and experience in insurance
  • Successful completion of 5 years as a Claims Examiner
Skill Sets
  • Excellent written and oral communication skills
  • Strong analytical and problem solving skills
  • Strong organization and time management skills
  • Experience in negotiation, mediations, arbitrations and monitoring trials on higher value complex claims
  • Ability to influence claims stakeholders and to effectively direct claims strategy
  • Strong vendor management skills are required including the ability to provide direction and guidance to defense attorneys, independent adjusters, building consultants, forensic accountants and other experts while controlling expenses.
  • Ability to assist with technical training to team claim handlers as required
  • Well developed and advanced expertise and knowledge in most technically complex claims topics
  • Policy language skills enabling accurate and consistent policy wording interpretation
  • Experience in effectively following up on recommendations from technical claims audits and continuous file handling improvement.
  • Ability to deliver outstanding customer service
  • Intermediate skills in Microsoft Office products (Excel, Outlook, Power Point, Word)
  • Ability to work in a team environment
  • Strong desire for continuous improvement
Who we are:

Markel Group (NYSE - MKL) a fortune 500 company with over 60 offices in 20+ countries, is a holding company for insurance, reinsurance, specialist advisory and investment operations around the world.

We're all about people | We win together | We strive for better

We enjoy the everyday | We think further

What's in it for you:

In keeping with the values of the Markel Style, we strive to support our employees in living their lives to the fullest at home and at work.
  • We offer competitive benefit programs that help meet our diverse and changing environment as well as support our employees' needs at all stages of life.
  • All full-time employees have the option to select from multiple health, dental and vision insurance plan options and optional life, disability, and AD&D insurance.
  • We also offer a 401(k) with employer match contributions, an Employee Stock Purchase Plan, PTO, corporate holidays and floating holidays, parental leave.
  • Markel offers hybrid working schedules of 3 days in the office and 2 days remote.
Are you ready to play your part?

Choose 'Apply Now' to fill out our short application, so that we can find out more about you.

The base salary offered for the successful candidate will be based on compensable factors such as job-relevant education, job-relevant experience, training, licensure, demonstrated competencies, geographic location, and other factors.

Caution: Employment scams

Markel is aware of employment-related scams where scammers will impersonate recruiters by sending fake job offers to those actively seeking employment in order to steal personal information. Frequently, the scammer will reach out to individuals who have posted their resume online. These "job offers" include convincing offer letters and frequently ask for confidential personal information. Therefore, for your safety, please note that:
  • All legitimate job postings with Markel will be posted on No other URL should be trusted for job Markel Group Careers.
  • All legitimate communications with Markel recruiters will come from Markel.com email addresses.


Markel is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of any protected characteristic. This includes race; color; sex; religion; creed; national origin or place of birth; ancestry; age; disability; affectional or sexual orientation; gender expression or identity; genetic information, sickle cell trait, or atypical hereditary cellular or blood trait; refusal to submit to genetic tests or make genetic test results available; medical condition; citizenship status; pregnancy, childbirth, or related medical conditions; marital status, civil union status, domestic partnership status, familial status, or family responsibilities; military or veteran status, including unfavorable discharge from military service; personal appearance, height, or weight; matriculation or political affiliation; expunged juvenile records; arrest and court records where prohibited by applicable law; status as a victim of domestic or sexual violence; public assistance status; order of protection status; status as a smoker or nonsmoker; membership or activity in local commissions; the use or nonuse of lawful products off employer premises during non-work hours; declining to attend meetings or participate in communications about religious or political matters; or any other classification protected by applicable law.

Should you require any accommodation through the application process, please send an e-mail to the [redacted].

No agencies please.

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