We are seeking a detail-oriented and analytical Claims Service Representative to manage lower exposure claims in alignment with company policies, procedures, and industry standards. This role involves investigating losses, evaluating claims, and ensuring fair and timely claim disposition while maintaining positive relationships with clients and stakeholders. The ideal candidate will have a background in claims management, preferably in medical malpractice or health benefit claims, and a strong understanding of reinsurance products such as Provider Stop Loss.

• Administer exposure claims in accordance with company policies, procedures, and applicable state laws.
• Collaborate with clients, claimants, vendors, field personnel, and other internal/external resources to gather necessary information.
• Investigate losses to determine cause, scope, extent of damages, liability, and potential subrogation opportunities.
• Evaluate claims to set reserves, make appropriate payments, and ensure accurate documentation of all activities.
• Review large data files submitted by clients, analyze claims data, and price it against sold policies.
• Assist in difficult claims processing and provide support in claims management as needed.
• Communicate effectively with claimants, clients, and stakeholders to achieve high levels of satisfaction and maintain positive relationships.
• Support producers in reviewing losses from the past year and discussing market trends.
• Develop towards managing accounts within the Provider Stop Loss product. 
• Client-facing work, providing SME knowledge to both internal and external stakeholders. 

Required Qualifications:

• High school diploma or equivalent.
• Minimum of 1 year of related experience in claims management.
• Appropriate licensing and/or certification in all states where claims are handled.
• Proficiency in MS Office applications and claims-related business software.
• Solid analytical skills to make decisions and resolve issues inherent in claims handling.
• Strong organizational skills to manage workload and respond to multiple demands.
• Excellent verbal and written communication skills.

Preferred Experience:

• Familiarity with Provider Stop Loss, HMO reinsurance, or managed care reinsurance products designed to cover catastrophic claims.
• Experience in medical malpractice claims or health benefit claims, including reviewing, accepting, or denying claims.
• Knowledge of medical coding, billing, or working in a health plan or health carrier environment.
• Ability to analyze claims data and understand reinsurance layers that protect entities from catastrophic claims.

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We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. 

Below are the minimum core benefits you’ll get, depending on your job level these benefits may improve:

• Medical/dental/vision plans, which start from day one!
• Life and accident insurance
• 401(K) and Roth options
• Tax-advantaged accounts (HSA, FSA)
• Educational expense reimbursement
• Paid parental leave

Other benefits include:

• Digital mental health services (Talkspace)
• Flexible work hours (availability varies by office and job function)
• Training programs
• Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
• Charitable matching gift program
• And more...

**The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process.

We value inclusion and diversity

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Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.

Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.

Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws.

Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.