Complex Claims Specialist

Liberty Mutual; Weatogue (CT); Híbrido; USD 120.000 - 180.000; Jornada completa

Descripción de la vacante

Liberty Mutual has an opening for a Complex Claims Specialist to join our Long-Term Care Claims Team. This is a high-visibility, hands-on role for an experienced Professional Liability claims handler with deep LTC facility expertise.

With minimal supervision, the Complex Claims Specialist will manage a book of specialty LTC Professional Liability Claims through the entire lifecycle, applying advanced coverage interpretation, clinical issue spotting, complex litigation management and prudent

Formación

• Bachelor's and/or advanced degree; J.D. is a plus.
• 7+ years claims/legal experience, with at least 2 years within a technical specialty.
• Healthcare claims experience strongly desired (Long-Term Care Professional Liability, Miscellaneous Medical Facilities and/or Group Practice claims).
• Advanced knowledge of claims handling concepts, practices and techniques, to include coverage issues and product line knowledge.
• Functional knowledge of law and insurance regulations in various jurisdictions.
• Demonstrated advanced verbal and written communications skills.
• Obtain and maintain Adjuster's license.

Responsabilidades

• Own and manage LTC Professional Liability Claims from first notice through resolution: investigate, analyze coverage, evaluate liability and damages, establish and adjust reserves, negotiate settlements and close files within authority.
• Perform advanced coverage analysis (duty to defend vs. indemnify, occurrence vs. claims-made, allocation, additional insured issues, contractual liability, tail exposures, endorsements) and prepare clear coverage opinions and reservation of rights/declination communications.
• Document claims thoroughly using Claims Management System and proactively diary follow-up actions and deadlines.
• Set indemnity and expense reserves within authority; elevate and recommend reserves for matters outside authority; review reserves regularly and justify reserve positions to management and auditors.
• Manage litigation: retain and oversee outside defense counsel with LTC expertise, control budgets and billing, direct discovery strategy, and evaluate mediation/arbitration/trial risk to optimize resolution.
• Coordinate clinical resources and expert consultants (nursing, pharmacy, infection control, medical specialists) for chart review, causation analysis and expert testimony.
• Interface with regulatory, compliance and risk management teams on CMS/state surveys, licensing investigations and mandatory reporting; incorporate regulatory developments into case strategy.
• Collaborate with underwriting, reinsurance and subrogation on allocation, ceded reporting and recovery opportunities.
• Identify and report claim trends, coverage exposures and policy issues to management and underwriting; contribute to playbooks, training and process improvements.
• Participate in mediations and arbitrations within settlement authority and support major loss response efforts.
• Maintain required adjuster licenses and adhere to company litigation and billing guidelines.

Conocimientos

Advanced claims handling

Analytical skills

Negotiation skills

Verbal & written communications

Adjuster licensure

Educación

Bachelor's degree

J.D. or advanced degree (plus)

Herramientas

Claims Management System

Descripción del empleo

Description

Liberty Mutual has an immediate opening for a Complex Claims Specialist to join our Long-Term Care Claims Team. This is a high-visibility, hands-on role for an experienced Professional Liability claims handler with deep Long-Term Care (LTC) facility expertise. With minimal supervision, the Complex Claims Specialist will manage a book of specialty LTC Professional Liability Claims through the entire lifecycle, applying advanced coverage interpretation, clinical issue spotting, complex litigation management and prudent reserving to resolve high-exposure matters economically and defensibly.

Why this role matters

Lead ownership of complex facility professional liability claims (nursing homes, assisted living, hospice, home health, ancillary providers).

Opportunity to shape claim strategy on high-severity matters, coordinate clinical/expert resources, and act as an internal subject-matter resource for underwriting, reinsurance and senior leadership.

Work in a collaborative environment with autonomy to influence outcomes and policy.

Key Responsibilities

• Own and manage LTC Professional Liability Claims from first notice through resolution: investigate, analyze coverage, evaluate liability and damages, establish and adjust reserves, negotiate settlements and close files within authority.
• Perform advanced coverage analysis (duty to defend vs. indemnify, occurrence vs. claims-made, allocation, additional insured issues, contractual liability, tail exposures, endorsements) and prepare clear coverage opinions and reservation of rights/declination communications.
• Document claims thoroughly using Claims Management System and proactively diary follow-up actions and deadlines.
• Set indemnity and expense reserves within authority; elevate and recommend reserves for matters outside authority; review reserves regularly and justify reserve positions to management and auditors.
• Manage litigation: retain and oversee outside defense counsel with LTC expertise, control budgets and billing, direct discovery strategy, and evaluate mediation/arbitration/trial risk to optimize resolution.
• Coordinate clinical resources and expert consultants (nursing, pharmacy, infection control, medical specialists) for chart review, causation analysis and expert testimony.
• Interface with regulatory, compliance and risk management teams on CMS/state surveys, licensing investigations and mandatory reporting; incorporate regulatory developments into case strategy.
• Collaborate with underwriting, reinsurance and subrogation on allocation, ceded reporting and recovery opportunities.
• Identify and report claim trends, coverage exposures and policy issues to management and underwriting; contribute to playbooks, training and process improvements.
• Participate in mediations and arbitrations within settlement authority and support major loss response efforts.
• Maintain required adjuster licenses and adhere to company litigation and billing guidelines.

*This position may have in-office requirements and other travel needs depending on candidate location. You will be required to go into an office twice a month if you reside within 50-miles of one of the following offices: Boston, MA; Hoffman Estates, IL; Indianapolis, IN; Lake Oswego, OR; Las Vegas, NV; Plano, TX; Suwanee, GA; Chandler, AZ; or Westborough, MA. We will consider a remote candidate if you do not live within 50-miles of one of these offices. This policy is subject to change.

We are open to fill this position depending on related professional skills and experience. The salary range reflects the varying pay scale that encompasses each of the Liberty Mutual regions, the salary for both levels, and the overall cost of labor for that region. Please note your salary range may not fall at the top of the posted range, depending on your location.

Qualifications

• Bachelors' and/or advanced degree. J.D. is a plus!
• 7 + years claims/legal experience, with at least 2 years within a technical specialty preferred.
• Healthcare Claims experience strongly desired (Long-Term Care Professional Liability, Miscellaneous Medical Facilities and/or Group Practice claims).
• Advanced knowledge of claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge.
• Functional knowledge of law and insurance regulations in various jurisdictions.
• Demonstrated advanced verbal and written communications skills.
• Demonstrated advanced analytical, decision making and negotiation skills.
• Obtain and maintain Adjuster's license.

About Us

Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Li