Complex Claims Specialist

Liberty Mutual•Weatogue, CT

3d•Hybrid

About The Position

Liberty Mutual is hiring a Complex Claims Specialist for its Long-Term Care Claims Team. This high-visibility, hands-on role is for an experienced Professional Liability claims handler with deep long-term care facility expertise. With minimal supervision, the specialist manages a portfolio of specialty LTC Professional Liability claims through the full claim lifecycle, using advanced coverage interpretation, clinical issue spotting, complex litigation management, and prudent reserving to resolve high-exposure matters economically and defensibly. The position owns complex facility professional liability claims involving nursing homes, assisted living, hospice, home health, and ancillary providers. The specialist shapes claim strategy, coordinates clinical and expert resources, and serves as an internal subject-matter resource for underwriting, reinsurance, and senior leadership. The role offers autonomy to influence outcomes and policy in a collaborative environment. The position may require office attendance and travel depending on the candidate’s location. Employees residing within 50 miles of a listed Liberty Mutual office must go into an office twice a month; candidates outside those areas may be considered for remote work. This policy is subject to change. The posted salary range varies by region, level, and local labor costs; an individual’s range may depend on location, skills, experience, education, and certifications.

Requirements

Bachelor’s and/or advanced degree.
At least 7 years of claims or legal experience.
Advanced knowledge of claims handling concepts, practices, and techniques, including coverage issues and product-line knowledge.
Functional knowledge of law and insurance regulations in various jurisdictions.
Advanced verbal and written communication skills.
Advanced analytical, decision-making, and negotiation skills.
Obtain and maintain an Adjuster’s license.

Nice To Haves

At least 2 years of experience within a technical specialty is preferred.
Healthcare claims experience is strongly desired, particularly Long-Term Care Professional Liability, Miscellaneous Medical Facilities, and/or Group Practice claims.
A J.D. is a plus.

Responsibilities

Manage LTC Professional Liability claims from first notice through resolution, including investigation, coverage analysis, liability and damages evaluation, reserving, settlement negotiation, and file closure within authority.
Conduct advanced coverage analysis, including duty to defend versus indemnify, occurrence versus claims-made coverage, allocation, additional insured issues, contractual liability, tail exposures, and endorsements; prepare coverage opinions and reservation of rights or declination communications.
Document claims in the Claims Management System and proactively diary follow-up actions and deadlines.
Set indemnity and expense reserves within authority; escalate and recommend reserves outside authority; regularly review and justify reserve positions to management and auditors.
Manage litigation by retaining and overseeing outside defense counsel with LTC expertise, controlling budgets and billing, directing discovery strategy, and evaluating mediation, arbitration, and trial risk.
Coordinate clinical resources and expert consultants, including nursing, pharmacy, infection control, and medical specialists, for chart reviews, causation analysis, and expert testimony.
Interface with regulatory, compliance, and risk management teams regarding CMS and 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 follow company litigation and billing guidelines.