Claim Counsel – Healthcare Professional Liability

This is a fully remote position, open to applicants in Alabama.

📋 Description

• Evaluate and interpret Medical Malpractice (MPL), Healthcare Professional Liability, General Liability (GL), and package insurance policies, encompassing claims-made and occurrence forms.

• Assess coverage matters pertaining to medical negligence, inadequate care, medication mistakes, misdiagnosis, and lack of patient monitoring.

• Review coverage for facility-related risks, including resident injuries, allegations of abuse, and premises liability under GL.

• Handle intricate issues involving policy triggers, retroactive dates, allocation between GL and PL, and multiple insured parties.

• Compose and dispatch coverage position letters, which include reservations of rights and denial correspondence.

• Supervise and manage complex claims associated with nursing homes, assisted living facilities, memory care institutions, and allied healthcare providers.

• Investigate claims involving falls, pressure ulcers, failure to supervise or transfer residents, allegations of abuse or neglect, and medication errors or treatment failures.

• Collaborate with medical experts, nursing staff, facility administrators, and defense attorneys to assess liability, causation, and damages.

• Analyze damages, including medical expenses, pain and suffering, wrongful death claims, and long-term care requirements.

• Formulate and implement strategic plans for claim resolution, overseeing litigation and multi-party claims.

• Assess exposure and devise settlement strategies that take into account both professional liability and general liability components of package policies.

• Recommend and manage reserves that reflect high-severity healthcare risks.

• Negotiate settlements and engage in mediations, settlement conferences, and complex litigation processes.

• Ensure adherence to Department of Insurance requirements and healthcare-related regulatory considerations.

• Maintain comprehensive documentation of coverage evaluations, claim strategies, and clinical/legal assessments within the claims system.

• Act as a trusted advisor to carriers and internal teams regarding healthcare liability trends and claim strategies.

• Serve as the primary point of contact with coverage attorneys, defense counsel, healthcare providers, administrators, and brokers.

• Deliver clear reports on coverage positions, exposure assessments, and resolution strategies.

⛳️ Requirements

• Juris Doctor (JD) with active bar membership in good standing, or 7–10+ years of senior-level experience in managing medical malpractice, healthcare liability, or complex professional liability claims.

• Active adjuster licenses and a commitment to obtain and maintain additional licenses as necessary.

• Proven expertise in analyzing medical malpractice and healthcare professional liability coverage.

• Experience in handling claims related to long-term care facilities, nursing homes, and assisted living providers.

• Strong grasp of clinical exposures, standards of care, and damages related to healthcare.

• Experience in managing claims that involve combined GL and professional liability (package) policies.

• Experience in issuing or advising on coverage positions.

• Exceptional analytical, negotiation, and communication capabilities.

• Ability to independently manage multiple high-severity claims.

• Background in long-term care programs, senior living, or allied healthcare claims (preferred).

• Experience in managing high-frequency, moderate-to-high severity healthcare claims portfolios (preferred).

• Familiarity with managing defense counsel, litigation strategies, and expert coordination in medical cases (preferred).

• Experience in program business or specialty healthcare liability environments (preferred).

🏝️ 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.

• Paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local regulations.