Complex Medical Claims Specialist

TEKsystems•Berwyn, IL

5d•$24 - $29•Remote

About The Position

The Claims Analyst is responsible for managing a portfolio of complex commercial insurance claims from initial investigation through resolution. This role requires strong analytical skills, sound judgment, and the ability to collaborate effectively with internal partners, external counsel, insureds, and claimants. The ideal candidate has experience handling commercial claims—such as general liability, auto liability, or professional liability—and excels in a fast‑paced, detail‑driven environment.

Requirements

Minimum 1–3 years of commercial claims experience must have medical malpractice experience
Strong understanding of policy interpretation, liability assessment, and claim negotiation.
Excellent communication, analytical, and organizational skills.

Responsibilities

Manage a caseload of complex commercial claims with significant exposure, ensuring each claim is handled efficiently and in accordance with company guidelines.
Conduct thorough investigations by gathering statements, reviewing contracts and documentation, interviewing involved parties, and coordinating with experts as needed.
Verify policy coverage, interpret policy language, and establish accurate and timely reserves.
Identify compensability, liability, and damages to determine claim validity and develop effective strategies for resolution.
Deliver exceptional customer service by maintaining proactive communication with insureds, claimants, attorneys, and internal stakeholders.
Provide timely updates, respond to inquiries promptly, and ensure all parties remain informed throughout the claim lifecycle.
Develop and execute strategic claim resolution plans, collaborating with coverage experts, legal partners, and internal teams.
Negotiate settlements, manage complex litigation when needed, and authorize payments within designated authority levels.
Identify potential subrogation or fraud opportunities and refer to appropriate internal departments.
Ensure claims are handled in alignment with regulatory requirements and internal protocols.
Maintain accurate, well‑documented claim files that meet quality and compliance standards.
Prepare summaries for leadership regarding high‑risk claims or significant exposures.
Establish and manage claim budgets, oversee expenses, and ensure resources are used efficiently.
Support timely and accurate billing, expense approval, and closure of claims.