Complex Claims Specialist, Miscellaneous Medical Facilities Professional Liability

Schedule: Full-Time
Salary Range: USD $82000.00 - $176000.00
Job Category: Claims

Description

Liberty Mutual has an immediate opening for a Complex Claims Specialist to join our Miscellaneous Medical Facilities Unit. This is a highvisibility, handson role for an experienced professionalliability claims handler with deep Miscellaneous Medical Facilities (MMF) and LongTerm Care (LTC) facility PL expertise. With minimal supervision, the Complex Claims Specialist will manage a book of specialty MMF/LTC Professional Liability Claims through the entire lifecycle, applying advanced coverage interpretation, clinical issue spotting, complex litigation management and prudent reserving to resolve highexposure matters economically and defensibly.

Why this role matters

• Lead ownership of complex facility professional liability claims (nursing homes, assisted living, hospice, home health, ancillary providers).
• Opportunity to shape claim strategy on highseverity matters, coordinate clinical/expert resources, and act as an internal subjectmatter resource for underwriting, reinsurance and senior leadership.
• Work in a collaborative environment with autonomy to influence outcomes and policy.

Key Responsibilities

• Own and manage MMF/LTC Professional Liability Claims from first notice through resolution: investigate, analyze coverage, evaluate liability and damages, establish and adjust reserves, negotiate settlements and close files within authority.
• Perform advanced coverage analysis (duty to defend vs. indemnify, occurrence vs. claimsmade, allocation, additional insured issues, contractual liability, tail exposures, endorsements) and prepare clear coverage opinions and reservation of rights/declination communications.
• Document claims thoroughly using Claims Management System and proactively diary followup actions and deadlines.
• Set indemnity and expense reserves within authority; escalate and recommend reserves for matters outside authority; review reserves regularly and justify reserve positions to management and auditors.
• Manage litigation: retain and oversee outside defense counsel with MMF/LTC expertise, control budgets and billing, direct discovery strategy, and evaluate mediation/arbitration/trial risk to optimize resolution.
• Coordinate clinical resources and expert consultants (nursing, pharmacy, infection control, medical specialists) for chart review, causation analysis and expert testimony.
• Interface with regulatory, compliance and risk management teams on CMS/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 adhere to company litigation and billing guidelines.

*This position may have in-office requirements and other travel needs depending on candidate location. You will be required to go into an office twice a month if you reside within 50-miles of one of the following offices: Boston, MA; Hoffman Estates, IL; Indianapolis, IN; Lake Oswego, OR; Las Vegas, NV; Plano, TX; Suwanee, GA; Chandler, AZ; or Westborough, MA.

We are open to fill this position depending on related professional skills and experience as a Senior Claims Specialist or Complex Claims Specialist. The salary range reflects the varying pay scale that encompasses each of the Liberty Mutual regions, the salary for both levels, and the overall cost of labor for that region. Qualifications

• Minimum 7 years of claims/legal experience with substantive, handson MMF and/or LTC Professional Liability claim handling; experience managing highseverity, multiclaimant or regulatory matters required.
• Demonstrated advanced knowledge of professional liability coverage interpretation and complex coverage issues.
• Strong litigation management experience, including selection and supervision of outside defense counsel, bill oversight and cost control.
• Practical understanding of clinical issues common to LTC/MMF (falls, pressure injuries, medication errors, infections/outbreaks, staffing/care plan issues) and relevant regulatory landscape (CMS surveys, state rules).
• Proven analytical, negotiation and written/verbal communication skills; able to present complex clinical and coverage positions to counsel, underwriters and senior management.
• Bachelor's degree required, and advanced degree is a plus!

About Us

Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.

As a purpose-driven organization, Liberty Mutual is committed to fostering an environment where employees from all backgrounds can build long and meaningful careers. Through strong relationships, comprehensive benefits and continuous learning opportunities, we seek to create an environment where employees can succeed, both professionally and personally.

At Liberty Mutual, we believe progress happens when people feel secure. By providing protection for the unexpected and delivering it with care, we help people embrace today and confidently pursue tomorrow.

We are dedicated to fostering an inclusive environment where employees from all backgrounds can build long and meaningful careers. By actively seeking employee feedback and amplifying the voices of our seven Employee Resource Groups (ERGs), which are open to all, we create an environment where every individual can make a meaningful impact so we continue to meet the evolving needs of our customers.

We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being.

Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.

Fair Chance Notices

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