Senior Complex Claims Consultant / Claims Counsel

Senior Complex Claims Consultant / Claims Counsel

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: Krystal Mutschler

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

Description

This role is 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 primarily on Employment Practices Liability (EPL) and Professional Liability claims, with additional exposure to Businessowners Policy (BOP) and General Liability (GL) claims within program structures.

This role serves as a key subject matter expert for coverage issues, advising internal teams and carriers on complex liability matters and ensuring claims are handled in accordance with applicable laws, regulations, and company guidelines.

This role is well-suited for either an attorney with insurance coverage experience or a senior complex claims professional with deep expertise in EPL, Professional Liability, and related coverage lines.

Key Responsibilities

• Review and interpret EPL, Professional Liability (E&O), BOP, and GL policies, endorsements, and applicable statutes.
• Analyze coverage issues including wrongful termination, discrimination, harassment, wage and hour exposures, professional negligence, and bodily injury/property damage triggers under GL.
• 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.

• Oversee and conduct complex claims investigations involving employment-related allegations, professional services exposures, and occasional GL-related losses.
• Analyze liability and damages in matters involving back pay, front pay, emotional distress, punitive damages, and economic loss.
• Develop and implement strategic approaches for claim resolution, including oversight of litigation when necessary.
• Provide carriers with independent evaluations of claims based on investigation, experience, and input from outside experts and counsel.

• Evaluate exposure and make settlement recommendations, including setting and managing reserves within carrier guidelines.
• Negotiate settlements within authority limits, balancing legal risk, financial exposure, and business objectives.
• Participate in mediations and settlement conferences as required.

• 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 internal teams and carriers on EPL, Professional Liability, and GL-related coverage issues.
• Act as the primary coverage and strategy resource in interactions with external counsel, policyholders, and other stakeholders.

Skills, knowledge & expertise

• Juris Doctor (JD) with active bar membership in good standing, or
• 7-10+ years of senior-level experience handling EPL, Professional Liability, GL, or similar complex liability claims.

• Active adjuster licenses and willingness to obtain and maintain additional licenses, as needed.
• Demonstrated expertise in insurance coverage analysis and policy interpretation.
• Experience issuing or advising on coverage positions, including RORs and denials.
• Strong understanding of liability, damages, and litigation strategy.
• Experience managing high-frequency EPL programs and familiarity with panel counsel management and billing guidelines in EPL matters.
• Exceptional analytical, negotiation, and communication skills.
• Ability to manage multiple high-severity, complex claims independently.
• Proficiency with claims management systems and related tools.

• Background in EPL, Professional Liability, or mixed program business including BOP/GL exposure.
• Experience working closely with coverage counsel or in-house legal teams.
• Prior involvement in program business or specialty lines 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.

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.