Senior Claims Examiner - Healthcare

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Job Summary

Arch Insurance Group Inc., AIGI, has an opening with the Claims Division on the Healthcare Team as a Senior Claims Examiner.

Responsibilities

Specific duties include but not limited to the below:

• Investigate, evaluate and resolve Healthcare claims, including claims involving long-term care.

• Develop and implement a strategy to resolve matters of liability and damages of a particular case

• Analyze coverage, liability and damages for purposes of assessing and recommending reserves

• Prepare and present written and oral reports to senior management setting forth all issues influencing evaluation and recommending reserves

• Manage excess accounts and perform audits

• Identify and assess coverage issues and draft coverage position letters 

• Maintain contact with the insured, underwriter, primary adjuster, counsel retained by primary carrier and the broker

• Make decisions whether to retain monitoring counsel, request tender of defense from primary or proceed with the litigation utilizing counsel retained by the primary

• Retain counsel when necessary and direct counsel in accordance with resolution strategy

• Attend mediations, trials, and other proceedings relevant to the resolution of the matter

• Travel to and from such locations within the United States 

• Select and utilize structure brokers

• Process invoice and indemnity payments 

Skills

• Exceptional communication (written and verbal), evaluating, influencing, negotiating, listening, and interpersonal skills to effectively develop productive working relationships with internal/external peers and other professionals across organizational lines

• Strong time management and organizational skills

• Ability to take part in active strategic discussions

• Ability to work well independently and in a team environment

• Hands-on experience and strong aptitude with Microsoft Excel, PowerPoint and Word

Education & Experience

• Bachelor’s degree; Juris Doctorate degree preferred

• Five (5) years of working experience  supporting commercial accounts for Healthcare claims including claims involving long term care

• Proper & active adjuster licensing in all applicable states

• Willing and able to travel 10%

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For individuals assigned or hired to work in California, Colorado, Hawaii, Jersey City, NJ; New York State; and/or Washington State, the base salary range is listed below. This range is as of the time of posting. Position is incentive eligible.

$124,085 - $167,555/year

• Total individual compensation (base salary, short & long-term incentives) offered will take into account a number of factors including but not limited to geographic location, scope & responsibilities of the role, qualifications, talent availability & specialization as well as business needs.  The above range may be modified in the future

• Click here to learn more on available benefits

Do you like solving complex business problems, working with talented colleagues and have an innovative mindset? Arch may be a great fit for you. If this job isn’t the right fit but you’re interested in working for Arch, create a job alert! Simply create an account and opt in to receive emails when we have job openings that meet your criteria. Join our talent community to share your preferences directly with Arch’s Talent Acquisition team.