Internal Coverage Counsel – Claims

Location

Van Wert, OH;
Dublin, OH;
Alpharetta, GA;
Irving, TX

Hybrid or Remote based on location

Full time - salary

As an Internal Coverage Counsel - Claims, you will join a high-impact, in‑house legal role where your coverage expertise will shape smarter claims decisions, influence underwriting strategy, and drive consistency across the business. You’ll tackle complex commercial and personal lines matters, collaborate with cross‑functional teams, and build tools and guidance that elevate how coverage decisions are made.

• Leadership and Culture:
  Supports operational teams and senior management by providing timely, consistent, and defensible coverage guidance aligned with policy intent and claim handling best practices.
• Centralized resource:
  Serves as a centralized internal resource for coverage interpretation, promoting consistency across claim teams, jurisdictions, and lines of business.
• Stakeholder communication:
  Communicates clearly and proactively with Claims, Underwriting, Insurance Product, and other stakeholders to enable effective risk decisions and reduce friction created by inconsistent coverage positions.
• Legal governance:
  Promotes sound legal governance, including appropriate management of attorney‑client privilege and documentation practices in claims and coverage consultations.
• Claims Coverage Support:
  Provides legal analysis and guidance on personal lines and complex commercial lines claims involving coverage questions, including interpretation of forms, endorsements, exclusions, conditions, tenders, additional insured issues, and priority/other insurance disputes.
• Correspondence standardization:
  Reviews and standardizes key coverage correspondence, including reservations of rights, coverage position letters, denial letters, non‑waiver agreements, and tender response communications.
• Research and recommendations:
  Conducts targeted legal research and prepares written coverage assessments and recommendations for claim professionals and leadership, including identification of escalation triggers and extra‑contractual exposure considerations.
• Work‑product development:
  Develops and maintains reusable work product (templates, playbooks, issue‑spotting tools, and guidance notes) to improve quality and speed of coverage decisioning.
• Intake and triage:
  Implements and supports an intake, triage, and prioritization approach for coverage requests; establishes service expectations and feedback loops with claim teams.
• Outside counsel management:
  Manages the use of outside counsel for novel, high complexity, or high exposure coverage matters; scopes assignments appropriately, enforces budget discipline, and captures lessons learned for internal knowledge sharing.
• Training:
  Delivers training to claim professionals on recurring coverage issues, quality documentation, and best practices for defensible coverage communications.
• Insurance Product and Underwriting Support:
  Provides coverage and form interpretation support to Insurance Product and Underwriting on personal lines and commercial lines to enable consistent underwriting intent and claim outcomes.
• Form and endorsement review:
  Participates in form and endorsement reviews, offering recommendations to improve clarity, reduce ambiguity, and minimize preventable coverage disputes.
• Insight communication:
  Identifies recurring coverage issues and claim dispute drivers and communicates actionable insights to Product and Underwriting, including opportunities for wording clarification or process improvements.
• Cross‑functional alignment:
  Participates in cross‑functional working sessions to align coverage interpretation, underwriting strategy, and claims handling practices as the organization grows or expands into new markets.
• Claims Compliance Support:
  Provides targeted guidance to support regulatory compliance, audit readiness, and adherence to claims handling standards, including documentation, timeliness, and required notices.
• Medicare claims compliance:
  Supports Medicare‑related and other claims compliance obligations as applicable by providing process guidance and training to reduce operational risk.
• Compliance…