This role is responsible for managing and resolving high-severity, complex insurance claims with a strong emphasis on coverage analysis, policy interpretation, and strategic claim resolution. This role serves as a key subject matter expert for coverage issues, advising internal teams and carriers on complex liability matters and ensuring claims are handled in accordance with applicable laws, regulations, and company guidelines.
This role is well-suited for either an attorney with insurance coverage experience or a senior complex claims professional with deep expertise in policy interpretation and complex liability lines.
Key Responsibilities
Coverage Analysis
- Review and interpret insurance policies, endorsements, and applicable statutes to determine coverage and exclusions.
- Draft and issue coverage position letters, including reservation of rights and denial letters, ensuring clarity and compliance with legal standards.
- Evaluate and update coverage forms as needed by carrier.
Claims Investigation & Strategy
- Oversee and conduct investigations, including gathering evidence, reviewing reports, and analyzing liability and damages.
- Develop and implement strategies for claim resolution, including overseeing litigation management when necessary.
- Provide carrier with evaluation of claims based on experience, independent investigation, and opinions received from outside experts and counsels.
Negotiation & Settlement
- Evaluate and make settlement recommendations, including obtaining and setting reserves within carrier guidelines. Negotiate settlements within authority limits, balancing legal risk and business objectives.
- Attend in mediations, arbitrations, and hearings as required.
Regulatory Compliance
- Ensure all claims handling complies with Department of Insurance regulations and company protocols.
- Maintain accurate documentation in the claims management system, including legal analyses and strategic recommendations.
Collaboration & Communication
- Advise internal teams and carriers on legal aspects of claims, providing clear guidance and recommendations.
- Represent carriers in discussions with external counsel, policyholders, and other stakeholders.
Skills, knowledge & expertise
Required (one of the following):
- Juris Doctor (JD) with active bar membership in good standing, or
- 7–10+ years of senior-level experience handling complex liability claims (e.g., commercial auto/trucking, general liability, excess/umbrella, professional liability).
Also required:
- Relevant certifications (e.g., claims adjuster licenses) and willingness to obtain additional licenses, if needed.
- Demonstrated expertise in insurance coverage analysis and policy interpretation.
- Experience issuing or advising on coverage positions, including RORs and denials.
- Strong understanding of liability, damages, and litigation strategy.
- Exceptional analytical, negotiation, and communication skills.
- Ability to manage multiple high-severity, complex claims independently.
- Proficiency with claims management systems and related tools.
Preferred:
- Background in commercial trucking or other complex liability lines.
- Experience working closely with coverage counsel or in-house legal teams.
- Prior involvement in excess, umbrella, or specialty claims environments.