Complex Claims & Coverage Director

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

📋 Description

• Develop realistic scenarios that involve 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, conduct coverage-position analyses, prepare authority requests, devise litigation-management plans, create reserve rationales, and recommend escalation paths.

• Compose high-quality "golden" reference responses at a senior technical claims level.

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

• Pinpoint claim-handling positions that lack internal consistency, are unsupported by documentation, are operationally impractical, or exceed the authority of a non-lawyer claims professional.

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

• Engage in onboarding office hours and calibration sessions.

• Assist in training cutting-edge AI models using high-quality insurance reasoning data.

⛳️ Requirements

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

• Proven experience in assessing coverage issues and formulating claim strategies involving multiple parties, layers, policies, or jurisdictions.

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

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

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

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

• Preferred bonus qualifications include CPCU, AIC, SCLA, ARM, or a similar insurance designation.

• Familiarity with complex lines such as excess casualty, professional liability, directors and officers, cyber, environmental, and construction defect.

• Experience in managing mediations, trials, coverage disputes, or exposure beyond contractual limits.

• Previous home-office technical claims or claim governance experience is required.

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

• Must be capable of working as an independent contractor.

• Unable to sponsor H1-B or STEM OPT candidates.

🏝️ Benefits

• A flat payment of $800 upon successful completion of onboarding.

• Weekly payments processed through Stripe or Wise based on services provided.

• Opportunity for fully remote work on a flexible schedule.

• Minimum commitment of 20 hours per week, with an ideal target of 40+ hours.

• Competitive compensation.

• Project durations may be extended, shortened, or concluded early based on needs and performance.

• Reasonable accommodations available upon request.

• Referral payments of up to $320 for each successful referral.