Complex Claims & Coverage Director

This is a fully remote position, open to applicants in United States, +2 more countries.

📋 Description

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

• Formulate intricate claim strategies, coverage-position analyses, authority requests, litigation-management plans, reserve rationales, and recommendations for escalation.

• Compose "golden" reference responses that meet the standards of senior technical claims quality.

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

• Identify claim-handling positions that exhibit internal inconsistencies, lack record support, are operationally unrealistic, or exceed the authority of a non-lawyer claims professional.

• Deliver written feedback to the research team to enhance model performance.

• Engage in onboarding office hours and calibration sessions.

⛳️ Requirements

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

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

• Familiarity with insurer duties, reservation-of-rights practices, litigation management, settlement authority, and escalation to internal or external legal counsel.

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

• Outstanding written reasoning, defensible judgment, and meticulous attention to detail.

• Proficiency in reviewing incomplete records and distinguishing between facts, assumptions, open issues, and recommended next steps.

• CPCU, AIC, SCLA, ARM, or a similar insurance designation is a plus.

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

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

• Experience in home-office technical claims or claim governance is a plus.

• Experience overseeing TPAs, independent adjusters, experts, or panel counsel is beneficial.

• This role does not require a law degree or a license to practice law.

🏝️ Benefits

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

• Earn up to $250 for each successful referral.

• Reasonable accommodations available upon request.