Complex Loss Specialist (Allied Health)

Integrated Specialty Coverages, LLC

Remote

87,000 - 109,000 a year

About Integrated Specialty Coverages

Integrated Specialty Coverages, LLC (ISC) is a growth stage technology and data-driven commercial MGA and insurance wholesaler leading innovation in the market.

Backed by one of the leading private equity firms, Onex Partners, and led by a forward-thinking management team, ISC is combining the worlds of insurance and technology to create an Insurtech powerhouse. As a leading online distributor of insurance products for a range of industries and "Main Street USA", we are looking for the right people to help us in our mission of achieving exponential growth. We strive to be the number one place to go for brokers and agents to source insurance. To accomplish this, we're building a digitally focused team that deeply understands the intersection between user experience, data, and AI/ML to optimize the way we engage with our customers and partners.

Job Summary

The Complex Loss Specialist position at Golden State Claims Services reports to a Claims Supervisor or Claims Manager and will specialize in Allied Health claims. The chief duty of the Complex Loss Specialist for Allied Health claims is to adjust the most time-intensive, complex, and high exposure losses that require a higher level of technical expertise, knowledge, and negotiating ability, for the program(s) to which is assigned. The Complex Loss Specialist will have a high level of ability to provide analysis and presentations to Senior Executives and Program Executives for these complex matters and will be well-versed in leading strategic roundtable discussions to determine optimal resolution strategy.

Position Responsibilities

Contribute to a collaborative environment by consistently demonstrating teamwork, high motivation, positive behavior, and effort to achieve goals and objectives.

Building and maintaining productive relationships with internal and external customers, including clients, underwriting and service teams, and agents

Research applicable coverage for our insureds. Document coverage dates, limits, and restrictions

Identify and resolve any potential coverage questions. Draft reservation of rights and coverage denials for review and approval by their Supervisor/Manager

Investigate facts of the loss by securing statements and supporting documentation such as contracts, cost of repair estimates, expert reports, photos, correspondence, etc.

Document activities in writing within claim files

Exercise judgment in applying legal liability to assigned claims and will have settlement authority up to their specific authority, which may vary from carrier to carrier.

Assign defense counsel to answer and defend lawsuits where appropriate. Monitor and direct defense counsel, independent adjusters, and experts.

Identify claims with potential exposure in excess of authority and advise their Supervisor/Manager

Evaluate, set, or recommend reserves for each file they are handling.

Prepare written reports as dictated by company policy and procedures.

Handle claims within guidelines of the Fair Claims Practices 790.03

Provide insureds, claimants, underwriters, and carriers with regular updates on status of file handling.

Discuss unique and complex files with Supervisor/Manager

Core Technical Duties

Healthcare liability claims investigation and evaluation, including medical malpractice, general liability, and professional liability exposures

Coverage analysis and interpretation of allied health professional liability policies, including review of coverage dates, limits, exclusions, and endorsements

Medical record review and interpretation across allied health disciplines (physical therapy, home health, diagnostics, behavioral health, etc.)

Drafting reservation of rights letters and coverage denial communications for supervisor review

Reserve evaluation, setting, and recommendation based on exposure analysis and claim trajectory

Litigation management, including assignment and direction of defense counsel, independent medical examiners, and expert witnesses

Investigation and Documentation

Securing recorded and written statements from insureds, claimants, and witnesses

Gathering and organizing supporting documentation including incident reports, medical records, licensing records, contracts, and expert reports

Maintaining accurate, detailed claim file documentation in compliance with carrier and program guidelines

Preparing written reports and roundtable summaries consistent with company policies and procedures

Minimum Qualifications

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

Benefits of Working at ISC

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/ADandD 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

Applicants may contact the ISC HR department via e-mail or phone to request and arrange for an accommodation that will allow the applicant to successfully complete the application process. Applicants needing assistance may request accommodation at any time.

NOTE: Never make payment to any employer, person, company, contractor or agency to get hired for a Job.

Contact ISC at: hr@iscmga.com or 760-599-7242.