Claims Counsel - Complex Adjusting

Claims Counsel - Complex Adjusting

Company:
Davies North America

Department:
Claims Administration & Adjusting

Location:

Home, United States

Compensation: $115,000 - $135,000 / year

Imagine being part of a team that’s not just shaping the future but actively driving it. At Davies North America
, we’re at the forefront of innovation and excellence, blending cutting‑edge technology with top‑tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors.

As a Claim Counsel, you will maintain a claim load, including managing and resolving complex insurance claims with a strong emphasis on legal analysis and compliance. Your responsibilities include interpreting policy language, providing opinions on coverage, and guiding claims toward fair and efficient resolution. You will collaborate closely with internal teams, carriers, and external stakeholders to ensure claims are handled in accordance with applicable laws, regulations, and company guidelines.

This role requires a Juris Doctor degree, active bar membership, and expertise in insurance law.

• Review and interpret insurance policies, endorsements, and applicable statutes to determine coverage and exclusions.
• Draft and issue coverage position letters, including reservation of rights and denial letters, ensuring clarity and compliance with legal standards.
• Evaluate and update coverage forms as needed by carrier.

• Develop and implement strategies for claim resolution, including overseeing litigation management when necessary.
• Provide carrier with evaluation of claims based on experience, independent investigation, and opinions received from outside experts and counsels.

• Evaluate and make settlement recommendations, including obtaining and setting reserves within carrier guidelines. Negotiate settlements within authority limits, balancing legal risk and business objectives.
• Attend mediations, arbitrations, and hearings as required.

• Ensure all claims handling complies with Department of Insurance regulations and company protocols.
• Maintain accurate documentation in the claims management system, including legal analyses and strategic recommendations.

• Advise internal teams and carriers on legal aspects of claims, providing clear guidance and recommendations.
• Represent carriers in discussions with external counsel, policyholders, and other stakeholders.

• Juris Doctor (JD) and active membership in a relevant State Bar in good standing.
• Strong knowledge of insurance policies, legal principles, and regulatory requirements.
• Exceptional analytical, negotiation, and communication skills.
• Proficiency in claims management systems and legal research tools.
• Ability to manage multiple complex claims independently and meet deadlines.

Note:

This job description provides a general overview of the typical responsibilities and qualifications of a claim counsel. Actual job duties may vary depending on the needs of the company.

• Medical, dental, and vision plans to ensure your health and that of your family.
• A 401k plan with employer matching to help you build a secure financial future.
• Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment.
• Paid holidays.
• Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.

Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity, and we actively promote an environment where all voices are valued and heard.

The salary range listed reflects the full compensation band for this role across all locations. Actual compensation will be based on factors such as skills, experience, qualifications, and geographic location, which may impact the final offer. We share ranges to remain transparent and consistent with pay equity practices.

Mid-Senior level

Full-time

Legal

Insurance