Overview
Department: Claims Administration & Adjusting
Location: Home United States
Compensation: $110,000 - $135,000 / year
This position involves managing and resolving high-severity, complex insurance claims with an emphasis on coverage analysis, policy interpretation, and strategic claim resolution. Primary focus is on Employment Practices Liability (EPL) and Professional Liability claims, with additional exposure to Businessowners Policy (BOP) and General Liability (GL) claims within program structures.
The role manages a portfolio of complex claims that may involve seven-figure exposures, class or collective action risk, discrimination, harassment, retaliation, wrongful termination, wage and hour allegations, professional negligence, breach of duty, reputational exposure, excess implications, and significant settlement negotiations.
Responsibilities
Complex EPL & Professional Liability Claims Management
- Independently manage a portfolio of high-severity EPL and professional liability claims from assignment through resolution.
- Handle matters involving significant financial exposure, including claims with seven-figure reserves, demands, settlements, or potential judgments.
- Evaluate liability, damages, employment law risk, professional negligence allegations, venue risk, reputational exposure, coverage position, and potential excess exposure.
- Analyze pleadings, employment records, personnel documentation, investigation materials, expert reports, wage and hour exposure models, settlement demands, and damages assessments.
- Develop and execute claim resolution strategies based on investigation, legal risk, policy obligations, litigation posture, and business objectives.
- Provide clear, independent evaluations and recommendations to carriers and internal stakeholders.
- Maintain accurate and thorough documentation of claim strategy, liability evaluation, damages analysis, reserves, coverage issues, and resolution activity.
Litigation Management & Strategy
- Oversee complex litigated EPL and professional liability claims, including discrimination, harassment, retaliation, wrongful termination, wage and hour, breach of duty, professional negligence, and other specialty liability matters.
- Direct and partner with defense counsel on litigation strategy, discovery, expert retention, dispositive motions, mediation preparation, and trial planning.
- Review and analyze pleadings, discovery responses, employment records, deposition summaries, expert reports, class or collective action exposure assessments, mediation briefs, and trial evaluations.
- Establish litigation plans, budgets, and key milestones in partnership with counsel and carriers.
- Attend and actively participate in mediations, settlement conferences, strategy meetings, and significant litigation events.
- Provide strategic recommendations regarding settlement, continued defense, alternative dispute resolution, or trial preparation.
Coverage Analysis & Policy Interpretation
- Review and interpret EPL, professional liability, E&O, management liability, excess, umbrella, and specialty liability policies.
- Analyze policy language, endorsements, exclusions, claims-made provisions, notice issues, prior acts, related claims, wage and hour exclusions, punitive damages issues, and allocation concerns.
- Provide recommendations related to defense obligations, indemnity exposure, reservation of rights, coverage defenses, and settlement authority.
- Draft, review, or provide input on reservation of rights letters, coverage position letters, disclaimers, and denial letters, as appropriate.
- Partner with coverage counsel, in-house legal teams, carriers, and internal stakeholders on complex coverage matters.
- Identify and escalate coverage disputes, bad faith concerns, excess exposure, regulatory issues, and other high-risk claim developments.
Settlement, Negotiation & Resolution
- Evaluate settlement demands and develop negotiation strategies based on liability, damages, employment law exposure, professional liability exposure, venue, coverage, reputational risk, and potential verdict exposure.
- Negotiate settlements within authority and make recommendations for matters requiring additional approval.
- Manage reserves in accordance with carrier guidelines and claim exposure.
- Participate in mediations and settlement conferences involving high-value EPL and professional liability disputes.
- Balance legal risk, financial exposure, policy obligations, reputational considerations, and business objectives when recommending claim resolution.
Requirements
Required (one of the following):
- Juris Doctor (JD) with active bar membership in good standing, or
- 7–10+ years of senior-level experience handling EPL, Professional Liability, GL, or similar complex liability claims.
In addition, candidates must have:
- Demonstrated experience handling claims with significant financial exposure, including seven-figure settlements, reserves, demands, or potential judgments.
- Strong litigation management experience, including directing outside counsel and developing litigation strategy.
- Experience evaluating liability, damages, coverage, reserves, settlement value, employment law risk, and trial risk.
- Demonstrated expertise in insurance coverage analysis and policy interpretation.
- Experience issuing, drafting, reviewing, or advising on coverage positions, including reservation of rights letters, disclaimers, or denial letters.
- Active adjuster licenses in applicable jurisdictions, or ability to obtain additional licenses as required.
- Strong negotiation, analytical, documentation, and communication skills.
Preferred Qualifications
- EPL, employment litigation, professional liability, E&O, management liability, wage and hour, class or collective action, or complex specialty liability claims experience.
- Experience working with employment defense counsel, coverage counsel, mediators, carriers, and insureds.
- Experience working in a Major Case Unit, Complex Claims Unit, Specialty Claims Unit, or Excess Claims environment.
- Prior experience as Claims Counsel, Coverage Counsel, National General Adjuster, Executive General Adjuster, Senior Claims Examiner, Complex Claims Specialist, or Senior Complex Claims Consultant.
- Strong understanding of bad faith risk, excess exposure, allocation, coverage litigation, reputational risk, and complex employment liability evaluation.
Compensation & Benefits
Salary Range: $110,000 - $135,000 / year
Benefits include:
- Medical, dental, and vision plans
- A 401(k) plan with employer matching
- Time-off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non-exempt employees
- Paid holidays
- Life insurance and short-term and long-term disability coverage
Benefit offerings, eligibility, and required employer contributions may vary based on role, classification, and applicable federal, state, and local laws tied to an employee’s primary work location.
Where required by law, paid sick leave, paid family and parental leave, and other mandated benefits may be provided in accordance with applicable state and local requirements.
Location & Work Expectations
- Maintain regular and dependable attendance.
- Be available and able to perform job responsibilities during established work hours.
Background Check & Legal Notices
- Any background check or review of criminal history, if applicable, will be conducted only after a conditional offer of employment and in compliance with applicable federal, state, and local laws, including fair-chance hiring requirements.
- Massachusetts Notice: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment.
AI Policy
While candidates may use AI and technology tools to prepare for interviews, interview responses and assessments are expected to reflect each individual's own experience, knowledge, and professional judgment.