# Senior Claim Representative / Claim Counsel **Company**: Davies **Location**: Home, Alabama **Work arrangement**: remote **Experience**: senior **Job type**: full-time **Category**: Insurance **Industry**: Insurance **Apply**: https://davies.pinpointhq.com/en/postings/28e4cfb3-663d-4a5c-bcc6-2ccce1b0d225?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply **Canonical**: https://yubhub.co/job/senior-claim-representative-claim-counsel-d1fad90e-470/ ## Description 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. For more fresh new jobs, check out [yubhub.co](https://yubhub.co/). ## Skills ### Required - Juris Doctor (JD) - insurance coverage analysis - policy interpretation - liability and damages evaluation - reserve analysis - litigation strategy ### Nice to have - Experience across two or more of the following: healthcare professional liability, long-term care, miscellaneous E&O, broker or insurance professionals E&O, third-party administrator liability, insurers’ extra-contractual liability, or D&O - Experience with both primary and excess claims, package policies, multi-insured matters, and matters involving overlapping professional liability and general liability exposures --- Source: [Apply at davies.pinpointhq.com](https://davies.pinpointhq.com/en/postings/28e4cfb3-663d-4a5c-bcc6-2ccce1b0d225?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)