Lead Claims Specialist

Risk Strategies Company

Lead Claims Specialist providing ultimate claim service for insurance claims at Risk Strategies. Advocating for clients, evaluating complex claims, and overseeing documentation and follow-ups.

Posted 5/6/2026full-timeRemote • Illinois, New York • 🇺🇸 United StatesSenior💰 $110,000 - $150,000 per yearWebsite

About the role

Key responsibilities & impact

Receive loss reports from Healthcare Clients and confirm that the claims are filed under the appropriate policy(ies)
Research policy terms and stipulations to determine coverage applicability and advocate for maximum recovery
Educate and address questions from Clients regarding claim reporting requirements
Advocate for the client, maintaining an active diary, transmittal of documentation, follow up calls, and emails to the client and carrier
Oversee the claims at the carriers to ensure timely investigation, liability determination, litigation and fair resolutions
Evaluate complex, high-exposure claims and interpret policy wording
Meet with clients when necessary and taking part in claim meetings, renewals and stewardship meetings
Vital liaison between Client, insurance carrier, Defense Counsel and other vendors
Perform Strategic Claim Reviews working in turn with Loss Control and Analytics
Counsel Clients on cost containment initiatives to reduce total claims, loss ratios, financials, timely file closure rates as well as timely reporting days

Requirements

What you’ll need

Valid P&C Brokers’ license or adjuster license – Multi State
Minimum of 7-10 years of experience as a specialist in dedicated industry
Must possess advanced knowledge of Property & Casualty coverages to include Healthcare Medical Professional Liability, Professional and General Liability for Healthcare systems and Cyber Liability
Familiarity with Claims Made and Occurrence policy forms with reporting protocols for Healthcare clients
Extensive knowledge of multi-line coverage and how coverage applies in the Healthcare industry
Demonstrate proficiency in computer applications, esp. Microsoft Office Suite
Possess the ability to provide superior customer service to both external and internal clients
Possess excellent client advocacy and negotiation skills
Ability to perform strategic claim review
Expertise in business practice area(s)
Possess claim management/consultative skills

Benefits

Comp & perks

Health insurance
401(k) matching
Flexible work hours
Paid time off

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims managementpolicy interpretationstrategic claim reviewcost containment initiativesmulti-line coverageHealthcare Medical Professional LiabilityProfessional LiabilityGeneral LiabilityCyber Liabilityreporting protocols

Soft Skills

client advocacynegotiation skillscustomer servicecommunicationorganizational skillsinterpersonal skillsproblem-solvingattention to detailtime managementcollaboration

Certifications

P&C Brokers’ licenseadjuster license