[Hiring] Senior Claim Specialist - Physician Claims @Gallagher

Role Description

The Senior Claims Specialist within GB Specialty is responsible for managing moderately complex Healthcare Professional Liability claims, with a primary focus on Physician Medical Malpractice exposures. This role manages the full claim life cycle, including:

• Coverage analysis
• Investigation
• Evaluation
• Resolution

Ensures claims are handled in accordance with client expectations, policy obligations, and regulatory requirements.

How you'll make an impact:

• Analyzes coverage and settles moderately complex claims in Healthcare Professional Liability focusing on Physician Claims (Medical Malpractice).
• Generally, does not work on workers’ compensation claims.
• Able to manage the full-life cycle of all assigned claims files.
• Analyzes coverage and determines defense obligations.
• Under minimal supervision, conducts thorough analysis and investigations necessary to determine claims exposure and recommend appropriate settlement strategies and action plans.
• Creates reservation of rights and coverage denial letters.
• Negotiates settlements with clients, client attorneys, and Public Adjusters.
• Interacts extensively with various parties involved in the claims process, and may recommend retaining the advice of outside experts as necessary.
• Prepares reserve and settlement authority requests for client and carrier approval.
• May act as a client advocate with carriers to ensure proper claims handling, including any necessary scoping, estimating, and addressing of coverage.
• Has a solid understanding of claims processing and the insurance brokerage business.
• Has a basic understanding of the terminology and case law associated with correctional medicine professional liability claims.
• Handles claims consistent with clients’ and corporate policies, procedures and best practices and in accordance with statutory, regulatory, and ethical requirements.
• Incumbents at this level should be able to work at full caseload capacity.

Qualifications

• Bachelor's Degree and 5+ years related claims experience required.
• Prior experience working within the applicable specialty claims area or demonstrated ability to handle unique/challenging claims issues.
• Appropriately licensed and/or certified in all states in which claims are being handled or able to obtain the licenses/certification per local requirements.
• Knowledge of accepted industry standards and practices.
• Computer experience with related claims and business software.

Requirements

• JD Highly Preferred.
• Licensed Attorney highly preferred.
• 2+ years of prior experience adjusting claims in Healthcare professional Liability.

Behaviors

• Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing, and embrace new challenges.
• Analytical skill necessary to make decisions and resolve issues inherent in handling of claims.
• Ability to successfully negotiate the settlement and disposition of claims including the ability to interpret related documentation.