Senior Claim Representative / Claim Counsel

Claim Counsel / Senior Complex Representative Imagine being part of a team that's not just shaping the future but actively driving it. At Davies North America, we're 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 7–10+ 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 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. 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 Davies North America