Senior Complex Claims Consultant / Claims Counsel - Healthcare Professional Liability

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: Matthew Arigo

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

Description

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 & expertise

• 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.

Equal Employment Opportunity & Legal Notices

• 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