Complex Claims and Coverage Director

This is a fully remote position, open to applicants in United States, +5 more countries.

📋 Description

• Develop realistic scenarios that encompass disputed coverage, reservations of rights, excess exposure, multiple insureds, various carriers, allocation, litigation, mediation, bad-faith risk, and strategies for high-severity settlements.

• Formulate intricate claim strategies, conduct coverage-position analyses, submit authority requests, create litigation-management plans, rationalize reserves, and provide escalation recommendations.

• Produce "golden" reference responses that meet senior technical claims quality standards.

• Evaluate AI-generated responses against structured rubrics that assess policy analysis, strategic judgment, factual support, stakeholder awareness, and discipline in escalation.

• Identify claim-handling positions that are inconsistent internally, lack support from the record, are operationally impractical, or exceed the authority of a non-lawyer claims professional.

• Offer written feedback aimed at enhancing model behavior.

• Engage in onboarding office hours and calibration sessions.

• Train advanced AI models utilizing high-quality insurance reasoning data.

⛳️ Requirements

• A minimum of 2 years of professional experience in managing complex, litigated, high-severity, or coverage-sensitive insurance claims.

• Proven experience in evaluating coverage issues and crafting claim strategies that involve multiple parties, layers, policies, or jurisdictions.

• Knowledge of insurer obligations, reservation-of-rights practices, litigation management, settlement authority, and the process of escalating matters to internal or external counsel.

• Capability to differentiate between an operational coverage position and formal legal advice, recognizing when specialized legal review is necessary.

• Excellent written reasoning skills, defensible judgment, and a keen attention to detail.

• Proficient in reviewing incomplete records while effectively distinguishing facts, assumptions, open issues, and recommending next steps.

• CPCU, AIC, SCLA, ARM, or similar insurance designations are considered a bonus qualification.

• Experience in excess casualty, professional liability, directors and officers, cyber, environmental, construction-defect, or other complex insurance lines is an advantage.

• Background in managing mediations, trials, coverage disputes, or extra-contractual exposure is a plus.

• Experience in home-office technical claims or claim governance is an additional advantage.

• Experience overseeing TPAs, independent adjusters, experts, or panel counsel is a valuable qualification.

• A law degree or license to practice law is not a requirement.

🏝️ Benefits

• Minimum of 20 hours per week (preferably 40+).

• Role available for immediate start.

• Reasonable accommodations provided upon request.