Complex Claims Specialist – MPL - job 1 of 2

job description:

The Role:

The Complex Claims Specialist is a high-level adjuster role that adjudicates assigned claims within given authority and provides operational support to the claims team. This person also:

• Adjusts and resolves complex to severe claims that includes all phases of litigation
• With minimal supervision, drafts complex coverage letters, including reservation of rights and denial letters
• Reviews and analyses claim documentation and legal filings
• Drives litigation best practices to lead defense strategy on litigated files
• Mentors Claim Examiners and Associate Claim Examiners
• Uses superior knowledge and experience to affect positive claim outcome via investigation, negotiation and utilization of alternative dispute resolutions
• Identifies emerging exposures and claims trends
• Identifies suspected fraudulent claims and tracks with special investigations unit
• Accurately documents claim files with all relevant claim documentation, correspondence and notes in compliance with company policies and applicable regulatory authorities
• Develops content and conducts training for claims team and underwriters as requested

The Team:

• Competitive salary and bonus (based on personal & company performance)
• 401(k) with competitive company matching
• Comprehensive health insurance, vision, dental and FSA plans (medical, limited purpose, and dependent care)
• Company paid group term life, short- term disability and long-term disability coverage
• 24 Paid time off days, 10 paid holidays, and ability to purchase 5 PTO days
• Paid parental leave
• 4 week paid sabbatical after every 5 years of service
• Financial Adoption Assistance and Medical Travel Reimbursement Programs
• Annual reimbursement up to $600 for health club membership or fees associated with any fitness program
• Company paid subscription to Headspace to support employees’ mental health and wellbeing
• Recipient of 2021 Cigna’s Well-Being Award for having a best-in-class health and wellness program
• Dynamic, creative and values-driven culture
• Modern and open office spaces, complimentary drinks
• Spirit of volunteerism, social responsibility and community involvement, including matching charitable donations for qualifying non-profits via our sister non-profit company, the Hiscox USA Foundation

person specification:

Requirements:

• 8+ years of claims handling experience. A JD from an ABA accredited law school may be considered as a supplement to claims handling experience
• Proven ability to positively affect complex claims outcomes through investigation, negotiation and effectively leading litigation
• Advanced knowledge of coverage within the team’s specialty or focus
• Advanced knowledge of litigation process and negotiation skills
• Experience in mentoring and training other claims examiners
• Excellent verbal and written communication skills
• Advanced analytical skills
• B.A./B.S degree from an accredited College or University preferred

Additional Factors Considered:

• Ability to act a subject matter expert within team
• Demonstrated ability to work with minimal oversight
• Experience attending and leading mediations, arbitrations and trials
• Demonstrated ability to advance product innovation or develop a greater understanding of other aspects of the business through training or other relevant projects
• Demonstrates courage in addressing and solving difficult or complex matters with insureds, attorneys and brokers
• Demonstrated steps taken toward additional certifications by an approved authority such as a CPCU, ARMS or AINS designation
• Commitment to professional development and learning demonstrated by at least 5 hours of continuing education related to insurance topics through Success Factory, Hiscox in-person or video conference training sessions, or other in-person seminars or webinars.