Claim Counsel - Healthcare Professional Liability

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: Matthew Arigo

Compensation: $110,000 - $135,000 / year

Description

Davies North America is looking for a candidate responsible for managing and resolving high-severity, complex insurance claims with a strong emphasis on coverage analysis, policy interpretation, and strategic claim resolution. The position focuses on Medical Malpractice and Healthcare Professional Liability claims, particularly within nursing homes, assisted living facilities, and allied healthcare programs, many of which are written as package policies that include both professional liability and general liability coverages.

This role serves as a key subject matter expert for healthcare liability coverage issues, advising internal teams and carriers on complex claims involving clinical care, facility operations, and regulatory exposures.

This role is well-suited for either an attorney with insurance coverage experience or a senior claims professional with deep expertise in medical malpractice, long-term care exposures, and healthcare liability programs.

Key Responsibilities

Coverage Analysis

• Review and interpret Medical Malpractice (MPL), Healthcare Professional Liability, GL, and package policies, including claims-made and occurrence forms.
• Analyze coverage issues related to medical negligence, failure to provide appropriate care, medication errors, misdiagnosis, and failure to monitor patients/residents.
• Evaluate coverage for facility-based exposures, including resident injuries, abuse allegations, and premises liability under GL.
• Address complex issues involving policy triggers, retroactive dates, allocation between GL and PL, and multiple insureds.
• Draft and issue coverage position letters, including reservations of rights and denial letters.

Claim Investigation & Strategy

• Oversee and manage complex claims involving nursing homes, assisted living facilities, memory care, and allied healthcare providers.
• Investigate allegations including falls, pressure ulcers, failure to supervise or transfer residents, abuse or neglect claims, and medication errors or treatment failures.
• Coordinate with medical experts, nurses, facility administrators, and defense counsel to evaluate liability, causation, and damages.
• Analyze damages including medical costs, pain and suffering, wrongful death, and long-term care needs.
• Develop and execute strategic plans for claim resolution, including oversight of litigation and multi-party claims.

Negotiation & Settlement

• Evaluate exposure and develop settlement strategies considering both professional liability and general liability components of package policies.
• Recommend and manage reserves reflecting high-severity healthcare exposures.
• Negotiate settlements and participate in mediations, settlement conferences, and complex litigation proceedings.

Regulatory Compliance & Documentation

• Ensure compliance with Department of Insurance requirements and healthcare-related regulatory considerations.
• Maintain clear documentation of coverage analyses, claim strategy, and clinical/legal evaluations in the claims system.

Collaboration & Communication

• Serve as a trusted advisor to carriers and internal teams on healthcare liability trends and claim strategy.
• Act as the primary liaison with coverage counsel, defense counsel, healthcare providers, administrators, and brokers.
• Provide clear reporting on coverage positions, exposure, and resolution strategies.

Skills, knowledge & expertise

Required (one of the following)

• Juris Doctor (JD) with active bar membership in good standing, or
• 7-10+ years of senior-level experience handling medical malpractice, healthcare liability, or complex professional liability claims.

Also required:

• Active adjuster licenses and willingness to obtain and maintain additional licenses, as needed.
• Demonstrated expertise in medical malpractice and healthcare professional liability coverage analysis.
• Experience handling claims involving long-term care facilities, nursing homes, and assisted living providers.
• Strong understanding of clinical exposures, standards of care, and healthcare-related damages.
• Experience managing claims involving combined GL and professional liability (package) policies.
• Experience issuing or advising on coverage positions.
• Excellent analytical, negotiation, and communication skills.
• Ability to manage multiple high-severity claims independently.

Preferred:

• Background in long-term care programs, senior living, or allied healthcare claim programs.
• Experience managing high-frequency, moderate-to-high severity healthcare claims portfolios.
• Familiarity with defense counsel management, litigation strategy, and expert coordination in medical cases.
• Experience working in program business or specialty healthcare liability environments.

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.