Claims Examiner - Healthcare

Job title: Claims Examiner - Healthcare in Atlanta, GA at Core Specialty Insurance Services, Inc.

Company: Core Specialty Insurance Services, Inc.

Job description: -As the Healthcare Claims Examiner, you will directly handle Healthcare Claims.Key Accountabilities/Deliverables:

• Ensure compliance with established claim handling guidelines regarding coverage, investigation, liability, damages, evaluation, and resolution.


• Provide oversight on claims portfolios within the primary casualty book. Maintain direct contact with insureds, agents, and brokers.


• Provide oversight on claims portfolios handled by TPAs within the excess casualty book.


• Engage in rigorous ALAE control and management, by competently selecting, instructing, and managing 3rd party vendors, as appropriate.


• Gather and analyse information necessary to make an accurate evaluation of the claim by delivering effective resolution of claims, make decision within established authority levels and identifying settlement issues.


• Establish reserves pursuant to established reserving protocols and reserve authority procedures.


• Successfully and proactively resolve complex and/or high exposure claims, promptly limiting exposure to the Company. Substantial involvement in mediation negotiations will be required.


• Adhere to the Panel Counsel Program and all Litigation Management Guidelines.


• Meet all Reporting Requirements by completing reports timely and accurately, including Large Loss Reports, etc.


• Liaise and attend meetings with the underwriting team regarding claim trends and other areas of interest.


• Work with external customers to address questions, resolve problems and maintain rapport.


• Occasional domestic travel may be required to attend mediations and / or trials.


• Undertaking general office administrative duties as and when required.


• Proactively expanding and maintaining awareness of the current market/industry and attend continuing educations programs when available.


• In addition to the above key responsibilities, you may be required to undertake other duties from time to time as the Company may reasonably require.

• Must possess a general understanding and knowledge of state and federal laws as they apply to US Specialty Healthcare claims.


• Must possess a general understanding of policy language/coverages applicable to US Specialty Healthcare.


• Must understand medical terminology.


• Computer skills – good working knowledge of Windows 10. MS Office, Excel and basic computer setup/troubleshooting.


• Previous experience with an electronic (paperless) claim system.

• College degree required.


• Must be licensed as a claims adjuster in their home state – multi-state licensure is preferred.


• A minimum of 5 years of claims adjusting or legal experience is required. A background in US Healthcare Professional/General Liability is preferred.


• A prior history of employment as a Healthcare professional or Medical Malpractice attorney is a plus.


• Must have experience handling Primary and Excess claims. Additional experience handling Reinsurance is preferred.


• Ability to travel for meetings, mediations and trials as required.


• Ability to negotiate and be persuasive.


• Possess strong communication and writing skills.


• Must be detail oriented and organized.


• Must possess the ability to work independently and as a team member.


• Must be a self-starter and possess problem solving skills.


• Must be able to manage pending caseloads, additional projects and meet all deadlines as set by management

Expected salary:

Location: Atlanta, GA

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