Senior Claim Representative / Claim Counsel

Davies; United States; A distancia; USD 110.000 - 140.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision plans

401(k) plan with employer matching

Paid time off (PTO)

Descripción de la vacante

Davies North America is seeking a Senior Claim Representative / Claim Counsel to manage high‑severity healthcare and specialty liability claims. You will provide independent coverage analyses, coordinate with carriers, and guide litigation strategies.

The role requires a JD with active bar admission and experience handling complex claims, with opportunities for collaboration across carriers, internal teams, and defense counsel.

Formación

• Juris Doctor (JD) with active bar membership in good standing and substantial experience in complex healthcare liability or specialty claims.
• Active adjuster licenses as required by jurisdictions and willingness to obtain additional licenses.
• Demonstrated expertise in insurance coverage analysis, policy interpretation, and reserves planning.

Responsabilidades

• Evaluate healthcare professional liability, E&O, and D&O coverage issues and analyze triggers, retroactive dates, and allocation.
• Draft coverage position letters and respond to carrier inquiries with precise regulatory and contractual knowledge.
• Direct investigations including review of medical, contracts, and regulatory materials to assess liability and damages.
• Coordinate with experts, defense counsel, and carriers to develop strategy and manage litigation posture.
• Develop settlement strategies and negotiate within delegated authority while balancing risk and business goals.
• Maintain documentation in claims systems with clear analyses of coverage, exposure, and reserves.

Conocimientos

Active bar membership

Insurance coverage analysis

Litigation strategy

Claims management systems

Analytical & written communication

Educación

Juris Doctor (JD)

Herramientas

Claims management systems

Descripción del empleo

Senior Claim Representative / Claim Counsel

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: Matthew Arigo

Compensation: $110,000 - $140,000 / year

Description

Our Story

Imagine being part of a team that’s not just shaping the future but actively driving it. At Davies North America, we’re at the forefront of innovation and excellence, blending cutting‑edge technology with top‑tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors.

The Claim Counsel / Senior Complex Representative manages high‑severity and technically complex claims across healthcare and specialty professional liability programs. The portfolio may include Medical Malpractice and Healthcare Professional Liability, Miscellaneous Errors & Omissions, broker and insurance professionals E&O, claims involving third‑party administrators and other insurance service providers, insurers’ extra‑contractual liability exposures, and Directors & Officers Liability.

The role serves as a subject matter resource to carriers and internal teams, providing independent evaluations of coverage, liability, damages, litigation posture, reserve adequacy, and resolution strategy. Depending on program needs, the position may also handle general liability components of healthcare package policies and other related specialty exposures.

This position is well‑suited for an attorney with insurance coverage and complex claims experience or a senior claims professional with substantial experience in healthcare liability, professional liability, management liability, or other specialty lines.

Key Responsibilities

• 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, ensuring clarity and compliance with legal and regulatory standards.
• 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.

• Direct and conduct timely, thorough investigations, including review of pleadings, contracts, medical records, claim files, facility records, professional services documentation, correspondence, regulatory materials, and other relevant evidence.
• For healthcare claims, coordinate with medical experts, nurses, facility personnel, administrators, and defense counsel to assess standards of care, causation, clinical issues, and damages
• For E&O and management liability claims, analyze the scope of professional services or management duties, alleged errors or omissions, economic loss, reliance, causation, contractual obligations, regulatory considerations, and available defenses.
• For extra-contractual claims, evaluate underlying claim‑handling facts, settlement opportunities, communications, damages, and applicable legal standards without prejudging coverage or liability.
• Develop, document, and execute claim strategies, action plans, and litigation management plans tailored to the applicable program and carrier requirements.
• Provide carriers with objective, concise, and timely reports addressing material facts, coverage, liability, damages, reserves, litigation developments, and recommended next steps.

• Select or work with approved defense counsel and experts, establish expectations, monitor performance, and ensure compliance with litigation and billing guidelines.
• Assess pleadings, dispositive motion opportunities, discovery strategy, expert needs, trial posture, and resolution options.
• Evaluate exposure and establish or recommend reserves in accordance with carrier guidelines and delegated authority.
• Develop settlement strategies and negotiate settlements within assigned authority, balancing legal risk, financial exposure, policy considerations, and business objectives.
• Participate in mediations, settlement conferences, claim reviews, and other proceedings as required.
• Identify opportunities for contribution, indemnity, contractual recovery, subrogation, or other risk transfer, where applicable.

• Ensure all claims handling complies with Department of Insurance regulations and internal protocols.
• Maintain accurate and thorough documentation in the claims management system, including coverage analyses and strategic recommendations.

• Serve as a trusted advisor to carriers, program stakeholders, and internal teams regarding coverage, exposure, litigation strategy, and claim resolution.
• 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 regarding both, status and strategy of claims as well as being able to respond quickly and accurately to carrier questions.
• Communicate complex legal, medical, financial, and coverage issues clearly and practically to both technical and non-technical audiences

Skills, knowledge & expertise

Required

• 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 based on assigned jurisdictions.
• 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, including reservations of rights and denials.
• Experience managing outside counsel, experts, mediations, and complex or high‑severity litigation.
• Excellent analytical, organizational, negotiation, reporting, and written and verbal communication skills.
• Ability to manage multiple complex claims independently while meeting deadlines, reporting requirements, and service expectations.
• Proficiency with claims management systems and standard business technology.

Preferred

• 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.
• Experience in program business, delegated authority, third‑party claims administration, or specialty insurance environments.
• Familiarity with healthcare regulations, insurance operations, professional services contracts, directors’ and officers’ duties, and extra‑contractual claim theories.
• Experience working closely with carrier claim teams, coverage counsel, in‑house legal teams, underwriting, or program management.

Equal Employment Opportunity & Legal Notices

Benefits

At Davies North America, we are dedicated to supporting the well‑being and future of our qualifying employees. Our comprehensive benefits package includes:

• Medical, dental, and vision plans to support your health and that of your family
• A 401(k) plan with employer matching
• Time‑off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non‑exempt employees
• Paid holidays
• Life insurance and short‑term and long‑term disability coverage

Benefit offerings, eligibility, and required employer contributions may vary based on role, classification, and applicable federal, state, and local laws, including those tied to an employee’s primary work location.

Where required by law, the Company provides paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements.

Diversity and Inclusion

Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity, and we actively promote an environment where all voices are valued and heard.

Compensation Transparency: The salary range listed reflects the full compensation band for this role across all locations. Actual compensation will be based on factors such as skills, experience, qualifications, and geographic location, which may impact the final offer. We share ranges to remain transparent and consistent with pay equity practices.

Essential Functions The following responsibilities and expectations are considered essential to the successful performance of this role. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform these essential functions.

• Maintain regular and dependable attendance.
• Be available and able to perform job responsibilities during established work hours.

Background Check & Fair Chance Compliance

Any background check or review of criminal history, if applicable to the role, will be conducted only after a conditional offer of employment and in compliance with applicable federal, state, and local laws, including fair‑chance hiring requirements.

Massachusetts Notice It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

AI Policy At Davies, we value authentic conversations and a fair candidate experience. While candidates may use AI and technology tools to prepare for interviews, we expect interview responses and assessments to reflect each individual's own experience, knowledge, and professional judgment. We do not use sites like Facebook, Craigslist, or Telegram to recruit or interview potential employees or contractors. If you have been asked to provide any information through any method other than our career portal, please email us at [e-mail]