Senior Claims Specialist - Senior Care GL & P&L

Position Overview

A leading organization is seeking a highly experienced Senior Claims Specialist to manage complex General Liability (GL) and Professional Liability (P&L) claims within the senior care space. This role is responsible for full lifecycle claim ownership-from initial notice through investigation, litigation management, and resolution.

The ideal candidate brings deep, hands-on claims handling expertise. Legal or clinical (nursing) backgrounds are highly valued, but must complement (not replace) demonstrated claims experience.

Key Responsibilities

• Independently manage a portfolio of senior care GL and P&L claims from intake through final resolution
• Conduct detailed investigations, including medical record review, incident evaluation, and facility documentation analysis
• Perform coverage analysis and liability assessments, ensuring clear and defensible documentation
• Identify severity drivers, fraud indicators, and litigation risks; escalate when appropriate
• Direct and manage defense counsel, including litigation strategy, budgeting, and performance oversight
• Evaluate claims for resolution, prepare settlement authority requests, and negotiate outcomes within granted authority
• Establish and maintain accurate reserves in alignment with internal guidelines
• Ensure timely and compliant claim documentation
• Collaborate with internal stakeholders, clinical reviewers, and legal partners to achieve optimal outcomes

Required Qualifications

• 5+ years of direct liability claims handling experience with full ownership of claims from intake through resolution
• Demonstrated experience managing litigated claims, including working with defense counsel and participating in settlement negotiations
• Strong knowledge of:
  • Coverage analysis
  • Liability assessment
  • Reserving practices
  • Claims resolution strategies
• Proven ability to handle moderate to high severity claims with sound judgment and defensible decision-making
• Ability to independently manage a caseload and meet deadlines in a structured, compliance-driven environment
• Excellent written and verbal communication skills, including claim summaries, exposure analyses, and settlement recommendations

Why Consider This Opportunity

• High-impact role handling meaningful, complex claims
• Exposure to both legal and clinical dimensions of liability
• Opportunity to operate with autonomy and influence claim outcomes