Claim Counsel – Healthcare Professional Liability

Responsibilities

• Review and interpret Medical Malpractice (MPL), Healthcare Professional Liability, GL, and package policies, including claims‑made and occurrence forms.
• Analyze coverage issues related to medical negligence, failure to provide appropriate care, medication errors, misdiagnosis, and failure to monitor patients/residents.
• Evaluate coverage for facility‑based exposures, including resident injuries, abuse allegations, and premises liability under GL.
• Address complex issues involving policy triggers, retroactive dates, allocation between GL and PL, and multiple insureds.
• Draft and issue coverage position letters, including reservations of rights and denial letters.
• Oversee and manage complex claims involving nursing homes, assisted living facilities, memory care, and allied healthcare providers.
• Investigate allegations including falls, pressure ulcers, failure to supervise or transfer residents, abuse or neglect claims, and medication errors or treatment failures.
• Coordinate with medical experts, nurses, facility administrators, and defense counsel to evaluate liability, causation, and damages.
• Analyze damages including medical costs, pain and suffering, wrongful death, and long‑term care needs.
• Develop and execute strategic plans for claim resolution, including oversight of litigation and multi‑party claims.
• Evaluate exposure and develop settlement strategies considering both professional liability and general liability components of package policies.
• Recommend and manage reserves reflecting high‑severity healthcare exposures.
• Negotiate settlements and participate in mediations, settlement conferences, and complex litigation proceedings.
• Ensure compliance with Department of Insurance requirements and healthcare‑related regulatory considerations.
• Maintain clear documentation of coverage analyses, claim strategy, and clinical/legal evaluations in the claims system.
• Serve as a trusted advisor to carriers and internal teams on healthcare liability trends and claim strategy.
• Act as the primary liaison with coverage counsel, defense counsel, healthcare providers, administrators, and brokers.
• Provide clear reporting on coverage positions, exposure, and resolution strategies.

Qualifications

• Juris Doctor (JD) with active bar membership in good standing, or 7–10+ years of senior‑level experience handling medical malpractice, healthcare liability, or complex professional liability claims.
• Active adjuster licenses and willingness to obtain and maintain additional licenses, as needed.
• Demonstrated expertise in medical malpractice and healthcare professional liability coverage analysis.
• Experience handling claims involving long‑term care facilities, nursing homes, and assisted living providers.
• Strong understanding of clinical exposures, standards of care, and healthcare‑related damages.
• Experience managing claims involving combined GL and professional liability (package) policies.
• Experience issuing or advising on coverage positions.
• Excellent analytical, negotiation, and communication skills.
• Ability to manage multiple high‑severity claims independently.
• Background in long‑term care programs, senior living, or allied healthcare claim programs (preferred).
• Experience managing high‑frequency, moderate‑to‑high severity healthcare claims portfolios (preferred).
• Familiarity with defense counsel management, litigation strategy, and expert coordination in medical cases (preferred).
• Experience working in program business or specialty healthcare liability environments (preferred).
• Core Competencies

Demonstrates expertise in Medical Malpractice and Healthcare Professional Liability coverage analysis, with a strong ability to manage complex claims involving nursing homes and assisted living facilities.

Proficient in negotiation, strategic claim resolution, and compliance with healthcare regulations.

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