Complex Claims & Coverage Director

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

📋 Description

• Develop realistic scenarios that involve disputed coverage, reservations of rights, excess exposure, multiple insured parties, various carriers, allocation, litigation, mediation, bad-faith risk, and high-severity settlement strategies.

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

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

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

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

• Offer written feedback to enhance model behavior.

• 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.

• Experience in evaluating coverage issues and formulating claim strategies that involve multiple parties, layers, policies, or jurisdictions.

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

• Ability to differentiate an operational coverage position from formal legal advice and to identify when specialized legal review is necessary.

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

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

• CPCU, AIC, SCLA, ARM, or a similar insurance designation (preferred).

• Experience in excess casualty, professional liability, directors and officers, cyber, environmental, construction-defect, or other complex lines (preferred).

• Experience managing mediations, trials, coverage disputes, or extra-contractual exposure (preferred).

• Background in home-office technical claims or claim governance (preferred).

• Experience supervising TPAs, independent adjusters, experts, or panel counsel (preferred).

• This role is intended for insurance practitioners and does not necessitate a law degree or license to practice law.

🏝️ Benefits

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

• Flexible remote work arrangement.

• Opportunity to influence the development of next-generation AI models.

• Participation in onboarding office hours and calibration sessions.

• Referral bonus of up to $250 for each successful referral.

• Reasonable accommodations available upon request.