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Complex Claims Specialist or Officer - Healthcare Programs - IronHealth

Employer
Liberty Mutual Insurance
Location
New York City, New York
Salary
Not Specified
Closing date
Sep 17, 2019

View more

Category
Claims, Health and Medical
Job Type
Not Specified
Career Level
Not Specified

Job Details

Advance your Claims career at Liberty Mutual Insurance- A Fortune 100 Company!

With minimal supervision, the Complex Claims Specialist will handle Healthcare Programs claims, throughout the entire claim's life cycle. Responsible for conducting investigations, recommending adequate reserves, monitoring, documenting, and settling/closing claims in an expeditious and economical manner within prescribed authority limits for the line of business.


Depending on experience, the position will either be for a Complex Claims Specialist or a Complex Claims Officer.

Responsibilities:

  • Analyzes, investigates, and evaluates the loss to determine coverage and claim disposition.

  • Utilizes CMS to document claims and to diary future events or follow-up.

  • Within prescribed settlement authority for line of business, establishes appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy.

  • Makes recommendations to set reserves at appropriate level for claims outside of authority level.

  • Prepares comprehensive reports as required.

  • Identifies and communicates specific claim trends and account and/or policy issues to management and underwriting.

  • Manages the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment. Pro-actively manages the case resolution process.

  • Actively participates in mediations and arbitrations, within limit of settlement authority. Participates in the claims audit process.

  • Provides claims marketing services by meeting with brokers, risk managers and reinsurers, as necessary.

  • As required, maintains insurance adjuster licenses.

Qualifications:

  • Bachelors' and/or advanced degree preferred.
  • 7+ years claims/legal experience, with at least 2 years within a technical specialty preferred.
  • Advanced knowledge of claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge.
  • Functional knowledge of law and insurance regulations in various jurisdictions.
  • Demonstrated advanced verbal and written communication skills
  • Demonstrated advanced analytical, decision making and negotiation skills.

Benefits:

We value your hard work, integrity and commitment to positive change. In return for your service, it’s our privilege to offer you benefits and rewards that support your life and well-being. To learn more about our benefit offerings please visit: https://LMI.co/Benefits

Overview:

At Liberty Mutual, we give motivated, accomplished professionals the opportunity to help us redefine what insurance means; to work for a global leader with a deep sense of humanity and a focus on improving and protecting everyday lives. We create an inspired, collaborative environment, where people can take ownership of their work; push breakthrough ideas; and feel confident that their contributions will be valued and their growth championed.

We’re dedicated to doing the right thing for our employees, because we know that their fulfillment and success leads us to great places. Life. Happiness. Innovation. Impact. Advancement. Whatever their pursuit, talented people find their path at Liberty Mutual.

Company

When people have a sense of security, they are free to relax, venture out, and live their lives. This is the feeling Liberty Mutual brings to the world every day. Founded in 1912, we are a global leader in property and casualty insurance, focused on protecting and preserving the lives and dreams of customers in more than 30 countries. With over 50,000 employees throughout the world, we offer you the chance to work for an evolving, growing company with a deep sense of humanity and a commitment to diversity and philanthropy. Join our team and go to work knowing that what you do matters. Because really it does.

 

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