Complex Loss Specialist – Allied Health
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Job Description
Complex Loss Specialist adjusting complex Allied Health claims for ISC, a technology-driven commercial MGA and insurance wholesaler. Evaluating coverage, liability, reserves, litigation, and high-exposure losses.
Responsibilities:
- Adjust the most time-intensive, complex, and high exposure Allied Health losses requiring advanced technical expertise, knowledge, and negotiating ability
- Provide analysis and presentations to Senior Executives and Program Executives
- Lead strategic roundtable discussions to determine optimal resolution strategy
- Build and maintain relationships with clients, underwriting and service teams, and agents
- Research applicable coverage and document coverage dates, limits, and restrictions
- Identify coverage questions and draft reservation of rights and coverage denials for review
- Investigate losses by securing statements and supporting documentation
- Document claim activities and maintain accurate claim files
- Apply legal liability and exercise settlement authority
- Assign, monitor, and direct defense counsel, independent adjusters, and experts
- Identify claims exceeding authority and advise the Supervisor/Manager
- Evaluate, set, or recommend reserves
- Prepare written reports and roundtable summaries
- Handle claims within Fair Claims Practices 790.03 guidelines
- Provide regular file-status updates to insureds, claimants, underwriters, and carriers
- Conduct healthcare liability claims investigation and evaluation, including medical malpractice, general liability, and professional liability exposures
- Analyze allied health professional liability policy coverage
- Review and interpret medical records across allied health disciplines
- Manage litigation, including defense counsel, independent medical examiners, and expert witnesses
- Gather and organize incident reports, medical records, licensing records, contracts, and expert reports
Requirements:
- Minimum of 10 years of claims experience, with an emphasis on complex Allied Health claims
- College degree or equivalent claims management experience required.
- Minimum of 10 years litigation management experience preferred.
- Must hold an individual adjusting license for a designated home State and be willing to secure additional required adjusting licenses as needed
- Active adjusters license under your name required
- Proficient computer skills including Microsoft Outlook, Word, and Excel.
- Ability to maintain consistent and clear communication with leadership, the team and all other external points of contact
- Must be legally authorized to work in the United States.
Benefits:
- Employee Ownership Program - every eligible employee shares in the financial rewards that grow when the company grows
- Professional development opportunities
- Owner Referral Program
- Work from home reimbursement for remote/hybrid roles
- Canary emergency financial assistance program
- Comprehensive medical, dental, vision
- Life/AD&D Insurance
- Confidential, Employee Assistance Program
- Health Savings Account, includes company contribution
- Short-term disability
- Voluntary benefits - supplemental accident, critical illness, hospital insurance
- Employee discounts
- 401(k) Plan with company match contribution
- Addition Wealth Financial Wellness Program
- Various Time Off Programs
- 11 company paid holidays
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