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Senior Insurance Claims Specialist
2 months ago
At Arch Capital Group Ltd., we foster a collaborative environment that emphasizes expertise and innovation. Our mission is to empower our clients, employees, investors, and communities to reach their highest potential. We are the driving force that enables others to achieve their objectives. In essence, We Enable PossibilitySM.
Position Summary
We are seeking a Senior Claims Examiner to join our Claims Division within the Healthcare Team. This role is pivotal in managing and resolving complex healthcare claims.
Key Responsibilities
The Senior Claims Examiner will be responsible for the following tasks:
- Conduct thorough investigations and evaluations of healthcare claims, particularly those related to long-term care.
- Formulate and execute strategies to address liability and damages pertinent to specific cases.
- Assess coverage, liability, and damages to recommend appropriate reserves.
- Prepare comprehensive written and oral reports for senior management detailing all relevant issues and reserve recommendations.
- Oversee excess accounts and conduct audits as necessary.
- Identify coverage issues and draft detailed coverage position letters.
- Maintain ongoing communication with insured parties, underwriters, primary adjusters, legal counsel, and brokers.
- Decide on the retention of monitoring counsel, request defense tenders from primary carriers, or initiate litigation with retained counsel.
- Engage and direct legal counsel as needed in alignment with resolution strategies.
- Participate in mediations, trials, and other relevant proceedings.
- Travel as required within the United States.
- Select and collaborate with structured brokers.
- Process invoices and indemnity payments efficiently.
- Outstanding communication skills (both written and verbal), along with strong abilities in evaluation, negotiation, and relationship-building across various organizational levels.
- Excellent time management and organizational capabilities.
- Proficient in engaging in strategic discussions.
- Ability to work independently as well as collaboratively within a team.
- Proficient in Microsoft Excel, PowerPoint, and Word.
- Bachelor's degree; Juris Doctorate is preferred.
- A minimum of five (5) years of experience managing commercial accounts in healthcare claims, including long-term care.
- Active adjuster licensing in all relevant states.
- Willingness to travel up to 10% of the time.
