Senior Complex Claims Consultant / Claims Counsel - Healthcare Professional LiabilityDepartment: Claims Administration & Adjusting
Employment Type: Permanent - Full Time
Location: Home United States
Reporting To: Matthew Arigo
Compensation: $110,000 - $135,000 / year
Description 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.
The successful candidate will manage a portfolio of complex healthcare liability claims that may involve seven-figure exposures, catastrophic injuries, wrongful death, complex causation issues, expert disputes, excess implications, and significant mediation or settlement activity. This role requires strong technical claims expertise, sound litigation judgment, coverage analysis capability, and the ability to partner effectively with carriers, insureds, defense counsel, coverage counsel, medical experts, and internal stakeholders.
This position is well-suited for either an attorney with healthcare liability, medical malpractice, insurance coverage, and litigation experience, or a senior complex claims professional with demonstrated experience managing high-exposure healthcare liability claims through investigation, litigation, mediation, settlement, and trial preparation.
Key Responsibilities- Independently manage a portfolio of high-severity healthcare professional liability claims from assignment through resolution.
- Handle matters involving significant financial exposure, including claims with seven-figure reserves, demands, settlements, or potential judgments.
- Evaluate liability, damages, causation, standard of care, medical documentation, venue risk, comparative fault, and potential excess exposure.
- Analyze medical records, expert reports, deposition testimony, defense assessments, and damages evaluations.
- Develop and execute claim resolution strategies based on investigation, legal exposure, coverage obligations, litigation posture, and business objectives.
- Provide clear, independent evaluations and recommendations to carriers and internal stakeholders.
- Maintain accurate and thorough documentation of claim strategy, liability evaluation, damages analysis, reserves, coverage issues, and resolution activity.
- Oversee complex litigated healthcare liability claims, including medical malpractice, hospital liability, physician liability, nursing liability, long-term care, and other healthcare-related professional liability matters.
- Direct and partner with defense counsel on litigation strategy, discovery, expert retention, dispositive motions, mediation preparation, and trial planning.
- Review and analyze pleadings, discovery responses, medical records, deposition summaries, expert reports, life care plans, economic loss evaluations, mediation briefs, and trial assessments.
- Establish litigation plans, budgets, and key milestones in partnership with counsel and carriers.
- Attend and actively participate in mediations, settlement conferences, strategy meetings, and significant litigation events.
- Provide strategic recommendations regarding settlement, continued defense, alternative dispute resolution, or trial preparation.
- Review and interpret healthcare professional liability policies, endorsements, exclusions, conditions, claims-made provisions, consent-to-settle provisions, and applicable statutes.
- Analyze coverage issues and provide recommendations regarding defense obligations, indemnity exposure, reservation of rights, and potential coverage defenses.
- Draft, review, or provide input on reservation of rights letters, coverage position letters, disclaimers, and denial letters, as appropriate.
- Partner with coverage counsel, in-house legal teams, carriers, and internal stakeholders on complex coverage matters.
- Identify and escalate coverage disputes, bad faith concerns, excess exposure, regulatory issues, and other high-risk claim developments.
- Evaluate settlement demands and develop negotiation strategies based on liability, damages, standard of care, causation, venue, coverage, and verdict exposure.
- Negotiate settlements within authority and make recommendations for matters requiring additional approval.
- Manage reserves in accordance with carrier guidelines and claim exposure.
- Participate in mediations and settlement conferences involving high-value healthcare liability disputes.
- Balance legal risk, financial exposure, policy obligations, and business objectives when recommending claim resolution.
- Ensure claims are handled in accordance with applicable Department of Insurance regulations, statutory requirements, carrier guidelines, and internal protocols.
- Maintain strong file documentation supporting liability analysis, damages evaluation, coverage positions, reserves, settlement strategy, and litigation direction.
- Monitor claims for compliance risks, including timeliness, communication standards, fair claims handling practices, and escalation requirements.
- Support audit readiness and quality claim handling expectations across assigned matters.
Skills, knowledge & expertiseRequired (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.
- Demonstrated experience handling claims with significant financial exposure, including seven-figure settlements, reserves, demands, or potential judgments.
- Strong litigation management experience, including directing outside counsel and developing litigation strategy.
- Experience evaluating liability, medical causation, damages, coverage, reserves, settlement value, and trial risk.
- Demonstrated expertise in insurance coverage analysis and policy interpretation.
- Experience issuing, drafting, reviewing, or advising on coverage positions, including reservation of rights letters, disclaimers, or denial letters.
- Active adjuster licenses in applicable jurisdictions, or ability to obtain additional licenses as required.
- Strong negotiation, analytical, documentation, and communication skills.
- Ability to independently manage multiple high-severity, complex claims in a fast-paced environment.
- Healthcare professional liability, medical malpractice, hospital liability, physician liability, nursing liability, allied health, or long-term care claims experience.
- Experience working in a Major Case Unit, Complex Claims Unit, Specialty Claims Unit, or Excess Claims environment.
- Prior experience as Claims Counsel, Coverage Counsel, National General Adjuster, Executive General Adjuster, Senior Claims Examiner, Complex Claims Specialist, or Senior Complex Claims Consultant.
- Experience managing matters through mediation, settlement conference, arbitration, trial preparation, or trial monitoring.
- Strong understanding of bad faith risk, excess exposure, coverage litigation, healthcare liability evaluation, and medical damages analysis.
BenefitsAt 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.
