Professional Liability Claims Consultant- Healthcare

Hanover Insurance Group, Inc.; Worcester (MA); Hybrid; USD 120,000 - 180,000; Full time

Benefits offered by this job

Remote work flexibility

Job summary

The Hanover Insurance Group, Inc. is seeking a Medical Professional Liability Claims Consultant to manage the full lifecycle of highly complex elder care and medical malpractice claims, with the option to work remotely.

This senior role emphasizes expert negotiation, coverage analysis, and cross‑functional collaboration to resolve high‑value exposures. Responsibilities include leading investigations, optimizing settlements, coordinating with internal and external experts, and ensuring regulatory

Qualifications

• Bachelor’s degree preferred; equivalent experience accepted, with 8+ years of relevant work experience required.
• JD preferred or equivalent legal/claims experience; Industry designations strongly preferred.
• Extensive experience handling highly complex, high-value claims with significant legal, financial, and reputational exposure.
• Recognized authority in negotiation and resolution of complex claims; able to shape best practices and influence outcomes.
• Demonstrated expertise in analyzing policy coverage, legal liability, and regulatory frameworks across jurisdictions.
• Proven ability to manage litigation strategy, direct counsel, and represent the company in trials, mediations, and arbitrations.
• Strong written and verbal communication skills; able to simplify complex information and handle sensitive issues with professionalism.

Responsibilities

• Independently lead investigations and manage the full lifecycle of highly complex, sensitive, and specialized claims.
• Analyze coverage, liability, and financial exposure; develop tailored resolution strategies and negotiate high-value or contested claims.
• Set activities, reserves, and authorize payments within high authority limits; manage litigation budgets and direct counsel payouts.
• Coordinate with internal and external experts to ensure thorough evaluations and resolution.
• Identify and pursue risk transfer opportunities; manage suspicious claims and refer to Special Investigation Unit as needed.
• Ensure compliance across jurisdictions including licensing, forms, deadlines, and accounting; maintain accurate and complete claim records.
• Protect PII and promote best practices across the team.
• Represent the company in litigation, mediations, settlement conferences, and arbitrations; provide large loss and reinsurance reporting to underwriting.
• Lead cross-functional meetings and collaborate with underwriting, agents, vendors, and legal teams to drive consensus and resolve claims.
• Identify coverage gaps and partner with product management to enhance offerings.
• Lead quality initiatives to streamline workflows; use data tools to analyze trends and correct inconsistencies.
• Maintain strong time and desk management skills; prepare reports and contribute to special projects.
• Attend industry events and continuing education seminars to stay current on best practices.
• Tailor communication strategies for specialized claims and maintain regular updates with leadership.
• Build and maintain strong relationships with customers and stakeholders.

Skills

Negotiation

Analytical thinking

Communication

Leadership

Education

Bachelor's degree

JD

CPCU

AIC

Job description

We are excited to announce an opportunity to join our healthcare claims team as a Medical Professional Liability Claims Consultant. This full‑time, exempt position offers the flexibility of working remotely while contributing to a high‑impact, collaborative team.

Position Overview:

The Claims Consultant role is a senior-level claims position responsible for the full lifecycle management of highly complex and high-value medical professional liability claims. This includes the investigation, evaluation, negotiation, and resolution of claims that represent the company’s largest damage exposures and often involve intricate coverage issues.

The position requires a high level of technical expertise and collaboration with professionals across various disciplines. Specialized claims handled in this role primarily focused on elder care facilities, medical negligence and additional medical malpractice.

In this role you will:

• Independently lead investigations and manage the full lifecycle of highly complex, sensitive, and specialized claims.

• Analyze coverage, liability, and financial exposure; develop tailored resolution strategies and negotiate high-value or contested claims.
• Set activities, reserves, and authorize payments within high authority limits; manage litigation budgets and direct counsel payouts.
• Coordinate with internal and external experts (e.g., forensic analysts, underwriters, legal counsel, contractors) to ensure thorough evaluations and resolution.
• Identify and pursue risk transfer opportunities; manage suspicious claims and refer to Special Investigation Unit as needed.
• Ensure compliance across jurisdictions including licensing, forms, deadlines, and accounting; maintain accurate and complete claim records.
• Protect personally identifiable information (PII) and promote best practices across the team.
• Represent the company in litigation, mediations, settlement conferences, and arbitrations; provide large loss and reinsurance reporting to underwriting.
• Lead cross-functional meetings and collaborate with underwriting, agents, vendors, and legal teams to drive consensus and resolve claims.
• Identify coverage gaps and partner with product management to enhance offerings.
• Lead quality initiatives to streamline workflows; use data tools to analyze trends and correct inconsistencies.
• Maintain strong time and desk management skills; prepare reports and contribute to special projects.
• Attend industry events and continuing education seminars to stay current on best practices.
• Tailor communication strategies for specialized claims and maintain regular updates with leadership.
• Build and maintain strong relationships with customers and stakeholders.

What you need to apply:

• Bachelor’s degree preferred; equivalent experience accepted, with 8+ years of relevant work experience required. JD preferred or equivalent legal/claims experience. Industry designations (e.g., CPCU, AIC) strongly preferred.
• Extensive experience handling highly complex, high-value claims with significant legal, financial, and reputational exposure.
• Recognized authority in negotiation and resolution of complex claims; able to shape best practices and influence outcomes.
• Demonstrated expertise in analyzing policy coverage, legal liability, and regulatory frameworks across jurisdictions.
• Proven ability to manage litigation strategy, direct counsel, and represent the company in trials, mediations, and arbitrations.
• Experience mentoring others and contributing to the development of investigative techniques, compliance protocols, and claims handling standards.
• Strong written and verbal communication skills; able to simplify complex information and handle sensitive issues with professionalism.
• Skilled in selecting appropriate communication channels and demonstrating empathy across diverse stakeholder groups.
• Ability to draft clear, factual, and objective work product without opinion.
• Highly organized with proven ability to manage complex workflows, projects, and competing priorities.
• Demonstrated time management and organizational skills; able to coach others in these areas.
• Deep understanding of insurance principles, coverage interpretation, and jurisdictional requirements.
• Strategic thinker with sound judgment; able to make informed decisions independently and assess financial implications.
• Expert in identifying and mitigating legal, regulatory, and reputational risks.
• Recognized for developing empathetic customer service strategies and delivering exceptional service.

Core Capabilities:

• Analytical Reasoning: The ability to identify problems, understand your impact, gather input and data, and develop an effective solution.
• Customer Centricity: Makes customers/clients and their needs a primary focus of one’s actions; shows interest in and understanding of the needs and expectations of internal and external customers; gains customer trust and respect; meets or exceeds customer expectations.
• Digital Fluency: Effectively uses digital tools and technology appropriately to find, evaluate, create, and communicate information understands how to navigate digital platforms, use software applications, and leverage technology for productivity and communication purposes.
• Persuasion and Influence: Uses appropriate interpersonal skills and techniques to gain acceptance for ideas or solutions; uses influencing strategies to gain genuine agreements; seeks to persuade rather than force solutions or impose decisions or regulations.
• Professional Insurance Acumen: Demonstrates a deepening understanding of the insurance industry and the ability to apply specialized technical skills to address complex challenges, adapt to industry trends, and drive value for the organization.
• Planning and Execution: Plans, prioritizes and manages resources and time effectively to achieve specific goals or deadlines.

Physical Demands and Work Environment:

• Ability to use a personal computer and other standard office equipment.

• Ability to sit and/or stand for extended periods.
• Required to work on-site as needed.
• Ability to travel as necessary.
• Ability to work in a fast paced, changing or stressful environment.
• Ability to perform work in a noisy/loud work environment.
• May be required to have and maintain sufficient home internet.