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. Job Data by YubHub .