Senior Claim Representative / Claim Counsel

The Claim Counsel / Senior Complex Representative manages high-severity and technically complex claims across healthcare and specialty professional liability programs.

Responsibilities:

Coverage Analysis

• Evaluate coverage issues specific to healthcare professional liability, miscellaneous and insurance professionals E&O, insurers’ extra-contractual liability, and D&O claims.
• Analyze claims-made and occurrence triggers, retroactive dates, prior knowledge and prior acts issues, interrelated claims, notice and reporting requirements, multiple insureds, allocation between coverages, and other complex coverage questions.
• Draft and issue coverage position letters, including reservations of rights and denial letters.
• Evaluate and provide input on coverage forms and policy language as needed by carriers.
• Review and interpret primary, excess, and package policies, endorsements, applications, and applicable law to determine coverage, exclusions, conditions, limits, retentions, allocation, and other obligations.

Claims Investigation & Strategy

• Direct and conduct timely, thorough investigations.
• Coordinate with medical experts, nurses, facility personnel, administrators, and defense counsel to assess standards of care, causation, clinical issues, and damages.
• Analyze the scope of professional services or management duties, alleged errors or omissions, economic loss, reliance, causation, contractual obligations, regulatory considerations, and available defenses.
• Develop, document, and execute claim strategies, action plans, and litigation management plans.
• Provide carriers with objective, concise, and timely reports.

Negotiation & Settlement

• Select or work with approved defense counsel and experts.
• Assess pleadings, dispositive motion opportunities, discovery strategy, expert needs, trial posture, and resolution options.
• Evaluate exposure and establish or recommend reserves.
• Develop settlement strategies and negotiate settlements.
• Participate in mediations, settlement conferences, claim reviews, and other proceedings.

Regulatory Compliance & Documentation

• Ensure all claims handling complies with Department of Insurance regulations and internal protocols.
• Maintain accurate and thorough documentation in the claims management system.

Collaboration & Communication

• Serve as a trusted advisor to carriers, program stakeholders, and internal teams.
• Act as a principal point of contact with policyholders, brokers, defense counsel, coverage counsel, experts, healthcare providers, administrators, and other stakeholders.
• Develop and deliver client presentations.

Skills, Knowledge & Expertise

• Juris Doctor (JD) with active bar membership in good standing, or generally 7–10+ years of senior-level experience handling complex healthcare liability, professional liability, management liability, insurance professionals E&O, or comparable specialty claims.
• Active adjuster license(s), as required, and willingness to obtain and maintain additional licenses.
• Demonstrated expertise in insurance coverage analysis, policy interpretation, liability and damages evaluation, reserve analysis, and litigation strategy.
• Experience drafting or substantively advising on coverage positions.
• Excellent analytical, organizational, negotiation, reporting, and written and verbal communication skills.

Benefits

• Medical, dental, and vision plans.
• A 401(k) plan with employer matching.
• Time-off policies.
• Paid holidays.
• Life insurance and short-term and long-term disability coverage.