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Liberty Mutual Insurance · 1 day ago

Complex Claims Specialist, Long Term Care Professional Liability

United States

Full-time

Remote

Senior Level

$92K/yr - $176K/yr

7+ years exp

Liberty Mutual Insurance is seeking a Complex Claims Specialist to join their Long-Term Care Claims Team. The role involves managing specialty LTC Professional Liability Claims through their entire lifecycle, applying advanced coverage interpretation and litigation management to resolve high-exposure matters. The position offers opportunities to shape claim strategies and collaborate with various internal teams.

FinanceFinancial ServicesInsurance

Responsibilities

Own and manage LTC Professional Liability Claims from first notice through resolution: investigate, analyze coverage, evaluate liability and damages, establish and adjust reserves, negotiate settlements and close files within authority

Perform advanced coverage analysis (duty to defend vs. indemnify, occurrence vs. claims-made, allocation, additional insured issues, contractual liability, tail exposures, endorsements) and prepare clear coverage opinions and reservation of rights/declination communications

Document claims thoroughly using Claims Management System and proactively diary follow-up actions and deadlines

Set indemnity and expense reserves within authority; escalate and recommend reserves for matters outside authority; review reserves regularly and justify reserve positions to management and auditors

Manage litigation: retain and oversee outside defense counsel with LTC expertise, control budgets and billing, direct discovery strategy, and evaluate mediation/arbitration/trial risk to optimize resolution

Coordinate clinical resources and expert consultants (nursing, pharmacy, infection control, medical specialists) for chart review, causation analysis and expert testimony

Interface with regulatory, compliance and risk management teams on CMS/state surveys, licensing investigations and mandatory reporting; incorporate regulatory developments into case strategy

Collaborate with underwriting, reinsurance and subrogation on allocation, ceded reporting and recovery opportunities

Identify and report claim trends, coverage exposures and policy issues to management and underwriting; contribute to playbooks, training and process improvements

Participate in mediations and arbitrations within settlement authority and support major loss response efforts

Maintain required adjuster licenses and adhere to company litigation and billing guidelines

Qualification

LTC Professional Liability ClaimsLitigation ManagementCoverage InterpretationClinical Issue UnderstandingAnalytical SkillsBachelor's DegreeNegotiation SkillsCommunication Skills

Required

Minimum 7 years of claims/legal experience with substantive, hands-on LTC Professional Liability claim handling; experience managing high-severity, multi-claimant or regulatory matters required

Demonstrated advanced knowledge of professional liability coverage interpretation and complex coverage issues

Strong litigation management experience, including selection and supervision of outside defense counsel, bill oversight and cost control

Practical understanding of clinical issues common to LTC (falls, pressure injuries, medication errors, infections/outbreaks, staffing/care plan issues) and relevant regulatory landscape

Proven analytical, negotiation and written/verbal communication skills; able to present complex clinical and coverage positions to counsel, underwriters and senior management

Bachelor's degree required