Senior Claims Examiner – Allied Healthcare

Hiscox

Senior Claims Examiner managing Allied Healthcare liability claims for Hiscox, a global specialist insurer. Investigating coverage, reserves, damages, and litigation through trial.

Posted 8/11/2026full-timeManhattan • Arizona, Connecticut, Illinois, Massachusetts, New York • 🇺🇸 United StatesSenior💰 $95,000 - $120,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in claims handling, particularly in Professional Liability and Allied Healthcare, with a strong focus on regulatory compliance, effective communication, and problem-solving. Capable of managing complex claims, conducting thorough investigations, and collaborating with various stakeholders to achieve optimal outcomes.

Highest-signal resume keywords

Claims Handling ExperienceProfessional Liability ExpertiseRegulatory Compliance KnowledgeStrong Negotiation SkillsEffective Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims InvestigationCoverage AnalysisReserve PracticesMedical Record ReviewLegal Document AnalysisLitigation ManagementClaims Management SystemsDocumentation ManagementRisk ManagementProblem-Solving

Soft Skills

Customer-Focused MindsetAttention to DetailOrganizational SkillsTime-Management SkillsEmpathetic Service

Tools & Technologies

Microsoft Office Applications

Certifications & Qualifications

Active Adjuster's License

Industry Keywords

Allied HealthcareMedical MalpracticeLong-Term CareBodily InjuryClaims Best PracticesStatutes of LimitationJurisdictional ConsiderationsInsuranceHealthcareLegal Studies

About the role

Key responsibilities & impact

Handle assigned claims within given authority and according to Hiscox Claims Best Practices
Analyze professional liability exposures involving Allied Healthcare providers, facilities, and services
Interpret policy language, endorsements, exclusions, limits, retentions, and coverage triggers
Develop and maintain claim action plans covering coverage, liability, damages, litigation strategy, reserves, and resolution opportunities
Conduct timely investigations of medical records, provider documentation, licensing information, contracts, and applicable standards of care
Evaluate complex causation and damages issues with defense counsel, medical experts, and consultants
Manage litigation through trial, including counsel selection, budgets, legal strategy, expert retention, mediation, settlement conferences, and trial preparation
Identify matters requiring escalation based on severity, coverage complexity, reputational risk, regulatory exposure, or potential excess involvement
Present significant or high-exposure claims at roundtables and document decisions and follow-up actions
Maintain accurate diaries, reserves, litigation plans, and reporting in accordance with internal Best Practices and regulatory requirements
Collaborate with underwriting, actuarial, risk management, brokers, and insureds to identify claim trends and risk-improvement opportunities
Deliver responsive, empathetic service to insured professionals and organizations during sensitive claim situations

Requirements

What you’ll need

1-3 years of claims handling experience with an insurance carrier, third-party administrator, law firm, healthcare organization, or related industry experience preferred
Experience handling Professional Liability, Allied Healthcare, Medical Malpractice, Long-Term Care, or Bodily Injury claims is a plus
Basic understanding of claims investigation, evaluation, and coverage analysis
Ability to gather facts, review documentation, and identify key issues impacting claim resolution
Developing knowledge of reserve practices, including establishing and adjusting reserves with guidance
Familiarity with claims-handling regulations, statutes of limitation, and jurisdictional considerations, or ability to quickly learn and apply regulatory requirements
Ability to manage a caseload of low to moderate complexity claims with accurate documentation, diary management, and timely communication
Problem-solving and analytical skills, including identifying and escalating potentially complex, sensitive, or high-exposure matters
Exposure to litigated claims or legal processes preferred
Ability to review and analyze medical records, legal documents, and claim-related information
Strong negotiation, communication, and customer service skills
Proficiency with Microsoft Office applications and ability to learn claims management systems
Active adjuster's license preferred but not required; ability to obtain required licensing within 90 days of employment
Bachelor's degree from an accredited college or university required
Coursework or experience in insurance, healthcare, legal studies, risk management, or a related field preferred
Strong organizational and time-management skills
Attention to detail and sound judgement
Customer-focused mindset
Effective written and verbal communication
Ability to learn quickly and adapt in a fast-paced environment
Collaborative approach to working with colleagues and business partners

Benefits

Comp & perks

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, 2 Hiscox 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
Dynamic, creative and values-driven culture
Modern and open office spaces, complimentary drinks