Arch

  • Senior Claims Examiner - Healthcare

    Job Locations US-NJ-Jersey City
    Job ID
    2019-2313
    # of Openings
    1
    Category
    Claims
  • The Position

    The Company

     

    Arch Insurance is a global insurer offering our clients superior coverage and service. We embody the Arch guiding principle of focusing on retaining experienced and talented employees to differentiate us from the rest of the pack. Our group operates from offices in the US, Canada, Bermuda, UK, Australia and South Africa, providing specialty risk solutions to clients worldwide across a wide range of industries. With over ten years of operating history and strong financial ratings, our track record remains solid.

     

    Arch Insurance employs a disciplined underwriting approach and prudent risk selection across all types of business. Our mission is to provide our insureds with superb coverage and claims handling through careful and diligent underwriting of risks and business-friendly solutions. Across our global operations, Arch Insurance employees are ready to meet your needs with professionalism and excellence.

     

    Job Responsibilities

    The Position

    Manage healthcare claims where Arch is the primary carrier.

     

    Job Responsibilities

     

    • Investigate, evaluate and resolve Healthcare claims.
    • Manage excess accounts and perform audits.
    • Identify and assess coverage issues, draft coverage position letters, and retain coverage counsel, when necessary as well as review coverage counsel's opinion letters and analysis.
    • Develop and implement strategy relative to coverage issues which correlate with the overall strategy of matters entrusted to the handler's care.
    • Develop and implement a strategy to resolve matters of liability and damages of a particular case.
    • Maintain contact with the insured, underwriter, primary adjuster, counsel retained by primary carrier and the broker.
    • Investigate claim, review primary's file, the insured's materials, pleadings, and other relevant documents.
    • Identify and review each jurisdiction's applicable statutes, rules and case law.
    • Review litigation materials including depositions and expert's reports.
    • Make decisions whether to retain monitoring counsel, request tender of defense from primary or proceed with the litigation utilizing counsel retained by the primary.
    • Retain counsel when necessary and direct counsel in accordance with resolution strategy.
    • Analyze coverage, liability and damages for purposes of assessing and recommending reserves. Prepare and present written and oral reports to senior management setting forth all issues influencing evaluation and recommending reserves.
    • Attend mediations, trials, and other proceedings relevant to the resolution of the matter.
    • Travel to and from such locations within the United States.
    • Negotiate resolution of claims.
    • Select and utilize structure brokers. Pay bills, invoices and process indemnity payments.
    • Maintain a diary of all claims, post reserves in a timely fashion, and expeditiously respond to inquiries from insured, counsel, underwriters, brokers and senior management regarding claims.

    Desired Skills/Experience

    Desired Skills

    • Strong evaluation and negotiation skills
    • Hands-on experience and strong aptitude with Microsoft Excel, PowerPoint and Word
    • Excellent written/verbal communication and organizational skills
    • Ability to work well in a team environment
    • Ability to take part in active strategic discussions

    Required Education/Experience

    • At least 5 years of related experience
    • Healthcare Claims experience preferred
    • J.D. degree a plus

     

     

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