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.

How Jobgether works

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

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