Making Numbers Make Sense
Claim Counsel – Healthcare Professional Liability
Location
Alabama
Posted
3 days ago
Salary
$110K - $135K / year
Seniority
Lead
Job Description
Claim Counsel – Healthcare Professional Liability
MDD Forensic Accountants
• 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.
Job Requirements
- 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).
Benefits
- Medical, dental, and vision plans to support your health and that of your family
- 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
- Paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements
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