[Hiring] Major Case Consultant Specialized Claims @The Hanover Insurance Group

Role Description

We are excited to announce an opportunity to join our healthcare claims team as a Major Case Consultant Specialized Claims. This full-time, exempt position offers the flexibility of working remotely while contributing to a high-impact, collaborative team.

The Major Case Consultant Specialized Claims role is a senior-level claims position responsible for the full lifecycle management of highly complex and high-value medical professional liability claims. This includes:

• Investigation, evaluation, negotiation, and resolution of claims.
• Handling claims that represent the company’s largest damage exposures.
• Managing intricate coverage issues.

Specialized claims handled in this role primarily focus on:

• Elder care facilities.
• Medical negligence.
• Additional medical malpractice.

In this role you will:

• Independently lead investigations and manage the full lifecycle of highly complex, sensitive, and specialized claims.
• Analyze coverage, liability, and financial exposure; develop tailored resolution strategies and negotiate high-value or contested claims.
• Set activities, reserves, and authorize payments within high authority limits; manage litigation budgets and direct counsel payouts.
• Coordinate with internal and external experts (e.g., forensic analysts, underwriters, legal counsel, contractors) to ensure thorough evaluations and resolution.
• Identify and pursue risk transfer opportunities; manage suspicious claims and refer to Special Investigation Unit as needed.
• Ensure compliance across jurisdictions including licensing, forms, deadlines, and accounting; maintain accurate and complete claim records.
• Protect personally identifiable information (PII) and promote best practices across the team.
• Represent the company in litigation, mediations, settlement conferences, and arbitrations; provide large loss and reinsurance reporting to underwriting.
• Lead cross-functional meetings and collaborate with underwriting, agents, vendors, and legal teams to drive consensus and resolve claims.
• Identify coverage gaps and partner with product management to enhance offerings.
• Lead quality initiatives to streamline workflows; use data tools to analyze trends and correct inconsistencies.
• Maintain strong time and desk management skills; prepare reports and contribute to special projects.
• Attend industry events and continuing education seminars to stay current on best practices.
• Tailor communication strategies for specialized claims and maintain regular updates with leadership.
• Build and maintain strong relationships with customers and stakeholders.

Qualifications

• Bachelor’s degree preferred; equivalent experience accepted.
• 8+ years of relevant work experience required.
• JD preferred or equivalent legal/claims experience.
• Industry designations (e.g., CPCU, AIC) strongly preferred.
• Extensive experience handling highly complex, high-value claims with significant legal, financial, and reputational exposure.
• Recognized authority in negotiation and resolution of complex claims.
• Demonstrated expertise in analyzing policy coverage, legal liability, and regulatory frameworks across jurisdictions.
• Proven ability to manage litigation strategy, direct counsel, and represent the company in trials, mediations, and arbitrations.
• Experience mentoring others and contributing to the development of investigative techniques, compliance protocols, and claims handling standards.
• Strong written and verbal communication skills.
• Ability to draft clear, factual, and objective work product without opinion.
• Highly organized with proven ability to manage complex workflows, projects, and competing priorities.
• Deep understanding of insurance principles, coverage interpretation, and jurisdictional requirements.
• Strategic thinker with sound judgment.
• Expert in identifying and mitigating legal, regulatory, and reputational risks.
• Recognized for developing empathetic customer service strategies.

Requirements

• Analytical Reasoning: Ability to identify problems and develop effective solutions.
• Customer Centricity: Focus on customer needs and expectations.
• Digital Fluency: Effectively use digital tools and technology.
• Persuasion and Influence: Use interpersonal skills to gain acceptance for ideas.
• Professional Insurance Acumen: Understanding of the insurance industry and ability to apply specialized skills.
• Planning and Execution: Manage resources and time effectively to achieve goals.

Benefits

• Medical, dental, vision, life, and disability insurance.
• 401K with a company match.
• Tuition reimbursement.
• PTO.
• Company paid holidays.
• Flexible work arrangements.
• Cultural Awareness Day in support of IDE.
• On-site medical/wellness center (Worcester only).