Senior Claims Specialist, HMO & PEI Claims

Description

Working under moderate direction, this role manages a book of specialty lines claims across the full claim lifecycle — from initial investigation through settlement and closure. The Claims Specialist conducts thorough investigations, recommends appropriate reserves, and resolves claims efficiently and cost-effectively within established authority limits for the line of business.

 

Responsibilities:

• Analyzes, investigates, and evaluates losses to determine coverage and appropriate claim disposition
• Documents claims and sets diaries for follow-up and key events using CMS
• Establishes appropriate indemnity and expense reserves within assigned settlement authority, reviewing regularly to ensure adequacy; recommends reserve levels for claims exceeding authority
• Prepares comprehensive claim reports as required
• Identifies emerging claim trends and account or policy issues, communicating findings to management and underwriting
• Manages the litigation process, including retaining counsel and overseeing case resolution
• Ensures adherence to line-of-business litigation guidelines, including budget management, bill review, and payment
• Actively participates in mediations and arbitrations within assigned settlement authority
• Participates in the claims audit process
• May support claims marketing efforts by engaging with brokers, risk managers, and reinsurers
• Maintains required insurance adjuster licenses

 

If the selected candidate lives within 50 miles of a GRS office, then the selected candidate must come into the office two days/month.

Qualifications

Qualifications:

• Bachelor's degree required; advanced degree preferred
• 5+ years of experience in claims handling, legal, or a related field
• Strong working knowledge of claims handling concepts, practices, and techniques, including coverage issues and product line expertise
• Solid understanding of insurance law and regulations across multiple jurisdictions
• Excellent verbal and written communication skills
• Strong negotiation skills, with the ability to resolve claims effectively within authority limits

 

Preferred Qualifications:

• Experience handling HMO and Provider Excess Claims

About Us

Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: https://www.libertymutualgroup.com/about-lm/careers/benefitsLiberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.Fair Chance Notices

• California
• Los Angeles Incorporated
• Los Angeles Unincorporated
• Philadelphia
• San Francisco