Senior Claims Examiner, Medical & Healthcare Claims (Insurance)

TL;DR

Senior Claims Examiner (Insurance): Resolving moderate to high complexity Medical and Healthcare claims with an accent on legal liability assessment and quantum analysis. Focus on managing litigated bodily injury claims, conducting loss investigations, and mitigating indemnity exposure.

Location: Must be based in the US (Red Bank NJ, Summit NJ, Scottsdale AZ, Rosemont IL, Boston MA, and other locations). US Work Authorization required; no visa sponsorship provided.

Salary: $73,600 - $107,250 + 15% bonus potential

Company

hirify.global Group is a Fortune 500 holding company specializing in insurance, reinsurance, specialist advisory, and investment operations worldwide.

What you will do

• Handle complex healthcare malpractice and negligence claims from coverage enquiry to final resolution.
• Conduct and direct investigations into loss facts and the extent of damages.
• Analyze insurance coverage and draft formal coverage position letters.
• Manage litigated and non-litigated bodily injury claims with values up to $450,000.
• Represent the company in mediations and monitor trials as required.
• Set reserves and provide technical guidance and training to other team members.

Requirements

• US Work Authorization is required (no visa sponsorship provided now or in the future).
• Bachelor’s degree or equivalent work experience; JD or advanced degree is a plus.
• 7-15 years of claims handling experience in the insurance industry.
• Minimum 5 years of successful experience specifically as a Claims Examiner.
• Must hold or be eligible to receive a claims adjuster license.
• Proven expertise in negotiation, mediation, and managing high-value complex claims.

Nice to have

• Industry designations such as INS, IEA, AIC, ARM, SCLA, or CPCU.
• Completion of industry training (e.g., CLM Claim College, Munich Re Training, FDCC).

Culture & Benefits

• Competitive health, dental, and vision insurance plan options.
• 401(k) with employer match contributions.
• Employee Stock Purchase Plan.
• Generous PTO, corporate holidays, and floating holidays.
• Paid parental leave.