VP, Senior Claims Coverage Counsel

 

As a member company of W. R. Berkley Corporation, Berkley Healthcare has assembled a unique team of multi-disciplinary insurance professionals to take a fresh look at healthcare organization insurance. We pride ourselves on our deep expertise in underwriting, claims and distribution in the healthcare industry insurance market. We understand that the healthcare industry is in a state of rapid evolution; shaped by emerging concepts in technology, law, public welfare and social economics, all with attendant enterprise risk unique to healthcare organizations. We apply cutting-edge insurance concepts to traditional healthcare insurance products that embrace the current complexity of the healthcare industry and give ultimate flexibility in managing enterprise risk.

 

This role will be ideally be based in our West Hartford, CT  or our Chesterfield, MO office.  We offer a hybrid work schedule with 4 days in the office; and 1 day remote where it makes sense to do so.  We'd consider a fully remote colleague as well. 

 

The Company is an equal employment opportunity employer.    #LI-AV1 #LI-REMOTE 

The VP, Senior Claims Coverage Counsel will be responsible for advising and assisting the Claims team on issues related to insurance coverage and claims handling procedures to ensure consistent and correct coverage positions are taken, as well as interpreting and implementing regulatory compliance requirements that impact claims handling in the healthcare insurance industry. 

 

What you can expect:

• Culture of innovation, teamwork, supportive colleagues and leaders willing to invest in talent
• Internal mobility opportunities 
• Visibility to senior leaders and partnership with cross functional teams
• Opportunity to impact change
• Benefits – competitive compensation, paid time off, comprehensive wellness benefits and programs, employer funded health savings account, profit sharing, 401k, paid parental leave, employee stock purchase plan, tuition assistance and professional continuing education

We'll count on you to:

• Conduct and coordinate research into a variety of claims coverage related issues across all segments within Berkley Healthcare and advises on appropriate claims coverage positions; 
• Draft, review and/or approve coverage correspondence, including internal coverage position statements, select reservation of rights, tender denial and disclaimer letters;
• Participate in the definition and development of policies, procedures and programs and provides continuing legal counsel and guidance; 
• Provide comprehensive, responsive and timely legal and strategic advice on claims coverage related issues;
• Facilitate consistency in coverage positions;
• Provide policy, coverage and compliance training to Claims, Claims Operations and Underwriting with limited supervision.
• Advise on claims handing procedures and assists in response to claim demands to help ensure adherence to best claim handling practices;.
• Manage extra-contractual litigation against the Company and other litigation management as directed by the Senior Vice President of Claims;
• Oversees outside counsel engaged for claims coverage related purposes;
• Communicate effectively with  clients, business partners, and attorneys on significant developments and unique issues that raise the potential for litigation on individual cases and across broader legal issues.
• Interpret, implement and administer policies, procedures and practices to ensure compliance with state and federal laws and regulations impacting healthcare claims, including but not limited to the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), National Practitioner Databank (NPDB) reporting, state required claim reporting, and state specific claim handling requirements such as adjuster licensure requirements as required by individual states.
• Establish procedures to fulfill all CMS reporting requirements, including but not limited to submitting queries to determine Medicare eligibility, submitting required reports to the CMS COBC, managing COBC claim response files, and performing ongoing administration of account, and activating and inactivating Responsible Reporting Entity (RRE) ID numbers for MMSEA reporting.
• Submit timely reports to state regulatory agencies on Berkley Healthcare’s behalf.
• Travel as needed to mediations, settlement conferences, trials and other proceedings.
• Contribute to a collaborative environment by raising new ideas, demonstrating teamwork, high motivation, positive behavior and effort to achieve goals and objectives.
• Build and maintain productive relationships with internal and external customers, including clients, underwriters and agents.
• Actively self-educates as to new state and federal laws and regulations and case law impacting coverage and compliance.

• JD degree from an ABA approved law school
• Licensed to practice law in at least one U.S. jurisdiction
• Minimum 8-10 years’ experience as a coverage attorney
• Self-motivated, independent and decisive;
• Excellent time management skills with ability to triage and prioritize;
• Exceptional collaboration with internal and external teams and partners;
• Strong oral and written communication skills with ability to articulate very complex facts, analysis and recommendations in a concise manner to senior leadership, insureds, and external business partners;
• Strong research skills; excellent ability to analyze and resolve complex situations; sound judgment and decision-making skills; attention to detail, and above-average organizational skills;
• Desire for new and varied job responsibilities beyond coverage analysis;
• Demonstrated ability to meet deadlines, determine priorities and adapt to changing priorities as needed with minimal supervision.

We do not accept any unsolicited resumes from external recruiting agencies or firms.

The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include:
• Base Salary Range: $200-250k
• Eligible to participate in annual discretionary bonus and long term incentive plan.
• Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.

The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Sponsorship not Offered for this Role