Note: The job is a remote job and is open to candidates in USA. Davies North America is at the forefront of innovation and excellence in the insurance and regulated sectors. They are seeking a Claim Counsel responsible for managing and resolving high-severity, complex insurance claims with a focus on Medical Malpractice and Healthcare Professional Liability claims.
Responsibilities
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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.
Company Overview