Senior Claim Representative / Claim Counsel

Accountabilities:

Manage a portfolio of high-severity and complex claims across healthcare professional liability, medical malpractice, miscellaneous errors and omissions (E&O), insurance professionals E&O, third-party administrator liability, insurers' extra-contractual liability, and Directors & Officers (D&O) coverage.
Conduct detailed insurance coverage analyses, interpreting primary, excess, and package policies, endorsements, applications, and applicable legal requirements.
Evaluate complex coverage issues, including claims-made and occurrence triggers, retroactive dates, prior knowledge, prior acts, interrelated claims, reporting requirements, multiple insureds, coverage allocation, exclusions, limits, and policy conditions.
Draft and issue comprehensive coverage position letters, including reservations of rights and denial letters, ensuring accuracy, clarity, and compliance with applicable legal and regulatory standards.
Review policy language and provide recommendations to insurance carriers regarding coverage forms, policy interpretation, and potential coverage issues.
Direct and coordinate thorough claims investigations, reviewing pleadings, contracts, medical records, facility documentation, professional services records, correspondence, regulatory materials, and other relevant evidence.
For healthcare-related claims, collaborate with medical experts, nurses, healthcare facility personnel, administrators, and defense counsel to assess standards of care, clinical issues, causation, and damages.
For professional and management liability claims, evaluate alleged errors and omissions, professional responsibilities, management duties, economic losses, contractual obligations, reliance, causation, regulatory considerations, and potential defenses.
Assess extra-contractual liability exposures by reviewing underlying claims-handling activities, settlement opportunities, communications, damages, and applicable legal standards.
Develop and implement tailored claims strategies, investigation plans, and litigation management approaches aligned with client and carrier requirements.
Prepare objective, detailed, and timely reports for insurance carriers covering material facts, coverage positions, liability assessments, damages, reserve adequacy, litigation developments, and recommended next steps.
Select or collaborate with approved defense counsel and external experts, establish performance expectations, monitor legal representation, and ensure compliance with litigation and billing guidelines.
Evaluate litigation strategies, including pleadings, discovery plans, dispositive motions, expert requirements, trial readiness, and potential settlement opportunities.
Assess financial exposure and establish or recommend appropriate reserves in accordance with delegated authority and carrier guidelines.
Develop and negotiate settlement strategies within assigned authority, balancing legal exposure, financial considerations, policy obligations, and business objectives.
Participate in mediations, settlement conferences, claim reviews, and other proceedings as required.
Identify opportunities for contribution, indemnification, contractual recovery, subrogation, and other risk transfer mechanisms where applicable.
Ensure all claims activities comply with relevant Department of Insurance regulations, legal requirements, and internal procedures.
Maintain complete and accurate documentation in claims management systems, including investigation findings, coverage assessments, strategic recommendations, and resolution decisions.
Serve as a trusted advisor to insurance carriers, program stakeholders, and internal teams on complex coverage questions, claims exposure, litigation strategy, and resolution options.
Maintain effective relationships with policyholders, brokers, defense and coverage counsel, experts, healthcare providers, administrators, and other relevant stakeholders.
Prepare and deliver client presentations on claim status, exposure, and strategy, while responding promptly and accurately to carrier inquiries.
Communicate complex legal, medical, financial, and insurance matters clearly and effectively to both technical and non-technical audiences.
Requirements:
Juris Doctor (JD) degree with active bar membership in good standing, or approximately 7–10+ years of senior-level experience managing complex healthcare liability, professional liability, management liability, insurance professionals E&O, or comparable specialty claims.
Active insurance adjuster license(s), where required, with the willingness and ability to obtain and maintain additional licenses based on assigned jurisdictions.
Extensive knowledge of insurance coverage analysis, policy interpretation, liability assessment, damages evaluation, reserve analysis, and litigation management.
Demonstrated experience drafting or substantively advising on complex coverage positions, including reservation of rights and denial letters.
Proven experience managing high-severity claims and complex litigation, including coordination with external defense counsel, coverage counsel, and subject matter experts.
Strong understanding of healthcare professional liability, medical malpractice, specialty E&O, management liability, and related insurance exposures.
Ability to interpret complex insurance policies, including primary and excess coverage, package policies, multi-insured arrangements, and overlapping professional and general liability exposures.
Experience managing investigations, evaluating legal and financial exposure, developing settlement strategies, and negotiating claim resolutions.
Strong understanding of applicable insurance regulations, claims-handling standards, healthcare-related legal considerations, and professional services obligations.
Excellent analytical and critical-thinking skills, with the ability to assess complex factual, legal, and financial information and make sound independent decisions.
Exceptional written and verbal communication skills, including the ability to prepare detailed reports, communicate coverage positions, and present complex matters to senior stakeholders.
Strong negotiation, organizational, and time management skills, with the ability to manage multiple complex claims independently while meeting deadlines and service expectations.
Demonstrated ability to build and maintain productive relationships with insurance carriers, clients, legal professionals, and cross-functional teams.
Proficiency in claims management systems and standard business technology.
Experience across two or more specialty insurance areas, such as 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, is preferred.
Experience handling both primary and excess claims, package policies, multi-insured matters, and claims involving overlapping coverage exposures is an advantage.
Previous experience in program business, delegated authority arrangements, third-party claims administration, or specialty insurance environments is highly desirable.
Familiarity with healthcare regulations, insurance operations, professional services contracts, directors' and officers' duties, and extra-contractual liability theories is preferred.
Experience collaborating with insurance carrier claims teams, in-house legal departments, coverage counsel, underwriting teams, and program management stakeholders is beneficial.
Strong professional judgment, accountability, attention to detail, and the ability to work independently in a fully remote environment.
Benefits:
Competitive annual salary: $110,000 – $140,000, depending on experience, qualifications, and geographic location.
Remote work flexibility: Fully remote position within the United States.
Medical insurance: Comprehensive medical coverage options for employees and eligible family members.
Dental and vision coverage: Insurance plans designed to support employee and family wellbeing.
Retirement savings: 401(k) plan with employer matching contributions.
Flexible time off: Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non-exempt employees.
Paid holidays: Additional paid holidays throughout the year.
Life insurance: Life insurance coverage to provide additional financial protection.
Disability coverage: Short-term and long-term disability insurance.
Family and parental support: Paid sick leave, family leave, and parental leave where required by applicable state and local regulations.
Inclusive workplace: Opportunity to join a diverse and collaborative professional environment that values different perspectives and experiences.
Professional development: Opportunity to strengthen expertise in complex claims management, specialty insurance, coverage analysis, and litigation strategy.