Claims Coverage Counsel/Claims Coverage Administrator

Merchants • Melville, NY

6d • Hybrid

About The Position

Merchants Insurance Group is hiring an experienced Claims Coverage Counsel or Claims Coverage Administrator for its Claim Legal Team in Melville, New York. This role handles first- and third-party coverage review, analysis, and decisions across all claim levels, including litigated claims. It prepares coverage opinions and position letters for complex coverage issues and disputes, and advises claims professionals on risk transfer opportunities, priority of coverage, and tender strategies.

The position assesses and directs coverage litigation strategy with outside counsel and claims professionals, including developing and executing plans to manage litigation through resolution. It also provides coverage guidance for declaratory judgment actions involving Merchants as a named party, and may support underwriting, product development, and regulatory compliance programs. The role reviews policy forms for updates and revisions to ensure compliance with state regulations, statutes, and case law, and provides claim, policy, regulatory, and legal expertise to management. It trains claims staff on policy interpretation, investigation, regulatory compliance, and good-faith claims practices across multiple venues.

The position is based in Melville, New York, with a hybrid schedule requiring two full days per week in the office and flexibility to work remotely or in the office on the remaining days. A law degree is preferred, but applicants without one may be considered if they have deep technical experience in significant and complex coverage matters, including New York construction and labor law and other commercial claims. Legal support to underwriting and product development, and supplementary regulatory research, are specified for JD candidates.

Requirements

• At least five years of insurance coverage experience and/or practicing attorney experience.
• At least ten years of technical experience in complex coverage analysis.
• Proficiency with Westlaw or other legal research applications.
• High competency in insurance coverage analysis, policy construction, and legal research, with exemplary writing skills.
• Ability to transfer knowledge through formal and informal training, with excellent written and oral presentation skills.
• Advanced written and oral communication skills, initiative, influence, and ability to communicate effectively across organizational levels and departments.
• Experience with construction and labor law litigation coverage issues related to risk transfer.
• Demonstrated creative problem-solving abilities.
• Excellent interpersonal skills and ability to lead and work cooperatively.

Nice To Haves

• Juris Doctor degree and a license in good standing.
• CPCU designation.
• Prior leadership experience.

Responsibilities

• Prepare coverage opinions and coverage position communications consistent with internal quality standards and applicable state regulations.
• Collaborate with front-line claims professionals and managers to analyze coverage and prepare or review coverage position letters for complex coverage issues or disputes.
• Assist claims professionals in evaluating risk transfer opportunities, priority of coverage, and tender strategies.
• Provide legal or coverage guidance to claims professionals handling declaratory judgment actions in which Merchants is a named party.
• Assess and direct coverage litigation strategy in conjunction with outside counsel and claims professionals, including planning and managing litigation through final resolution.
• Lead training for claims staff on legal and coverage matters, policy interpretation, investigation, regulatory compliance, and good-faith claims practices.
• Provide claim legal support to underwriting and product development teams.
• Assist regulatory compliance programs through supplementary research regarding applicable statutes and regulations.
• Review policy forms for updates and revisions and ensure compliance with state regulations, statutes, and case law.
• Provide claim, policy, regulatory, and legal expertise to management, including senior management.

Benefits

• Welcoming and positive work environment.
• Colleague appreciation events.
• Flexible work arrangements, including flex scheduling and summer hours.
• Hybrid work schedule.
• Competitive pay scale.
• Generous paid time off package.
• Health insurance.
• Dental insurance.
• Vision insurance.
• Life insurance.
• Short-term disability coverage.
• 401(k) employer match of 100% up to 6% of annual contributions; immediate 100% vesting in employer match dollars.
• Company bonus program.
• Tuition reimbursement.
• Equity component.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed