Senior Claim Representative Claim Counsel

Our Story

Imagine being part of a team thats not just shaping the future but actively driving it. At Davies North America were at the forefront of innovation and excellence blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group we help businesses navigate risk optimize operations and spearhead transformation in the insurance and regulated sectors.

The Claim Counsel / Senior Complex Representative manages high-severity and technically complex claims across healthcare and specialty professional liability programs. The portfolio may include Medical Malpractice and Healthcare Professional Liability Miscellaneous Errors & Omissions broker and insurance professionals E&O claims involving third-party administrators and other insurance service providers insurers extra-contractual liability exposures and Directors & Officers Liability.

The role serves as a subject matter resource to carriers and internal teams providing independent evaluations of coverage liability damages litigation posture reserve adequacy and resolution strategy. Depending on program needs the position may also handle general liability components of healthcare package policies and other related specialty exposures.

This position is well-suited for an attorney with insurance coverage and complex claims experience or a senior claims professional with substantial experience in healthcare liability professional liability management liability or other specialty lines.

Key Responsibilities

Coverage Analysis

• Evaluate coverage issues specific to healthcare professional liability miscellaneous and insurance professionals E&O insurers extra-contractual liability and D&O claims.
• Analyze claims-made and occurrence triggers retroactive dates prior knowledge and prior acts issues interrelated claims notice and reporting requirements multiple insureds allocation between coverages and other complex coverage questions.
• 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.
• Review and interpret primary excess and package policies endorsements applications and applicable law to determine coverage exclusions conditions limits retentions allocation and other obligations.

Claims Investigation & Strategy

• Direct and conduct timely thorough investigations including review of pleadings contracts medical records claim files facility records professional services documentation correspondence regulatory materials and other relevant evidence.
• For healthcare claims coordinate with medical experts nurses facility personnel administrators and defense counsel to assess standards of care causation clinical issues and damages
• For E&O and management liability claims analyze the scope of professional services or management duties alleged errors or omissions economic loss reliance causation contractual obligations regulatory considerations and available defenses.
• For extra-contractual claims evaluate underlying claim-handling facts settlement opportunities communications damages and applicable legal standards without prejudging coverage or liability.
• Develop document and execute claim strategies action plans and litigation management plans tailored to the applicable program and carrier requirements.
• Provide carriers with objective concise and timely reports addressing material facts coverage liability damages reserves litigation developments and recommended next steps.

Negotiation & Settlement

• Select or work with approved defense counsel and experts establish expectations monitor performance and ensure compliance with litigation and billing guidelines.
• Assess pleadings dispositive motion opportunities discovery strategy expert needs trial posture and resolution options.
• Evaluate exposure and establish or recommend reserves in accordance with carrier guidelines and delegated authority.
• Develop settlement strategies and negotiate settlements within assigned authority balancing legal risk financial exposure policy considerations and business objectives.
• Participate in mediations settlement conferences claim reviews and other proceedings as required.
• Identify opportunities for contribution indemnity contractual recovery subrogation or other risk transfer where applicable.

Regulatory Compliance & Documentation

• 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.

Collaboration & Communication

• Serve as a trusted advisor to carriers program stakeholders and internal teams regarding coverage exposure litigation strategy and claim resolution.
• Act as a principal point of contact with policyholders brokers defense counsel coverage counsel experts healthcare providers administrators and other stakeholders.
• Develop and deliver client presentations regarding both status and strategy of claims as well as being able to respond quickly and accurately to carrier questions.
• Communicate complex legal medical financial and coverage issues clearly and practically to both technical and non-technical audiences

Skills knowledge & expertise

Required

• Juris Doctor (JD) with active bar membership in good standing or generally 710 years of senior-level experience handling complex healthcare liability professional liability management liability insurance professionals E&O or comparable specialty claims.
• Active adjuster license(s) as required and willingness to obtain and maintain additional licenses based on assigned jurisdictions.
• Demonstrated expertise in insurance coverage analysis policy interpretation liability and damages evaluation reserve analysis and litigation strategy.
• Experience drafting or substantively advising on coverage positions including reservations of rights and denials.
• Experience managing outside counsel experts mediations and complex or high-severity litigation.
• Excellent analytical organizational negotiation reporting and written and verbal communication skills.
• Ability to manage multiple complex claims independently while meeting deadlines reporting requirements and service expectations.
• Proficiency with claims management systems and standard business technology.

Preferred

• Experience across two or more of the following: healthcare professional liability long-term care miscellaneous E&O broker or insurance professionals E&O third-party administrator liability insurers extra-contractual liability or D&O.
• Experience with both primary and excess claims package policies multi-insured matters and matters involving overlapping professional liability and general liability exposures.
• Experience in program business delegated authority third-party claims administration or specialty insurance environments.
• Familiarity with healthcare regulations insurance operations professional services contracts directors and officers duties and extra-contractual claim theories.
• Experience working closely with carrier claim teams coverage counsel in-house legal teams underwriting or program management.

Equal Employment Opportunity & Legal Notices

Benefits

At Davies North America we are dedicated to supporting the wellbeing 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
• Timeoff policies including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for nonexempt employees
• Paid holidays
• Life insurance and shortterm and longterm 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 employees 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.

Diversity and Inclusion

Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity and we actively promote an environment where all voices are valued and heard.

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.

Background Check & Fair Chance Compliance

Any background check or review of criminal history if applicable to the role will be conducted only after a conditional offer of employment and in compliance with applicable federal state and local laws including fairchance hiring requirements.

Massachusetts Notice
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

AI Policy
At Davies we value authentic conversations and a fair candidate experience. While candidates may use AI and technology tools to prepare for interviews we expect interview responses and assessments to reflect each individuals own experience knowledge and professional judgment.
We do not use sites like Facebook Craigslist or Telegram to recruit or interview potential employees or contractors. If you have been asked to provide any information through any method other than our career portal please email us at

Required Experience:

Senior IC