Major Case Consultant Specialized Claims- Healthcare

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we CARE through our values, Sustainability initiatives and inclusive corporate culture.

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.

Position Overview:

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 the investigation, evaluation, negotiation, and resolution of claims that represent the company’s largest damage exposures and often involve intricate coverage issues.

The position requires a high level of technical expertise and collaboration with professionals across various disciplines. Specialized claims handled in this role primarily focused on elder care facilities, medical negligence and 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.

What you need to apply:

• Bachelor’s degree preferred; equivalent experience accepted, with 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; able to shape best practices and influence outcomes.
• 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; able to simplify complex information and handle sensitive issues with professionalism.
• Skilled in selecting appropriate communication channels and demonstrating empathy across diverse stakeholder groups.
• Ability to draft clear, factual, and objective work product without opinion.
• Highly organized with proven ability to manage complex workflows, projects, and competing priorities.
• Demonstrated time management and organizational skills; able to coach others in these areas.
• Deep understanding of insurance principles, coverage interpretation, and jurisdictional requirements.
• Strategic thinker with sound judgment; able to make informed decisions independently and assess financial implications.
• Expert in identifying and mitigating legal, regulatory, and reputational risks.
• Recognized for developing empathetic customer service strategies and delivering exceptional service.

Core Capabilities:

• Analytical Reasoning: The ability to identify problems, understand your impact, gather input and data, and develop an effective solution.
• Customer Centricity: Makes customers/clients and their needs a primary focus of one’s actions; shows interest in and understanding of the needs and expectations of internal and external customers; gains customer trust and respect; meets or exceeds customer expectations.
• Digital Fluency: Effectively uses digital tools and technology appropriately to find, evaluate, create, and communicate information understands how to navigate digital platforms, use software applications, and leverage technology for productivity and communication purposes.
• Persuasion and Influence: Uses appropriate interpersonal skills and techniques to gain acceptance for ideas or solutions; uses influencing strategies to gain genuine agreements; seeks to persuade rather than force solutions or impose decisions or regulations.
• Professional Insurance Acumen: Demonstrates a deepening understanding of the insurance industry and the ability to apply specialized technical skills to address complex challenges, adapt to industry trends, and drive value for the organization.
• Planning and Execution: Plans, prioritizes and manages resources and time effectively to achieve specific goals or deadlines.

Physical Demands and Work Environment:

• Ability to use a personal computer and other standard office equipment.
• Ability to sit and/or stand for extended periods.
• Required to work on-site as needed.
• Ability to travel as necessary.
• Ability to work in a fast paced, changing or stressful environment.
• Ability to perform work in a noisy/loud work environment.
• May be required to have and maintain sufficient home internet.

CAREER DEVELOPMENT:

It’s not just a job, it’s a career, and we are here to support you every step of the way. We want you to be successful and fulfilled. Through on-the-job experiences, personalized coaching and our robust learning and development programs, we encourage you – at every level – to grow and develop.

BENEFITS:

We offer comprehensive benefits to help you be healthy, build financial security, and balance work and home life. At The Hanover, you’ll enjoy what you do and have the support you need to succeed.

Benefits include:

• 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)
• Click here for the full list of Benefits

EEO statement:

The Hanover values diversity in the workplace and among our customers. The company provides equal opportunity for employment and promotion to all qualified employees and applicants on the basis of experience, training, education, and ability to do the available work without regard to race, religion, color, age, sex/gender, sexual orientation, national origin, gender identity, disability, marital status, veteran status, genetic information, ancestry or any other status protected by law.

Furthermore, The Hanover Insurance Group is committed to providing an equal opportunity workplace that is free of discrimination and harassment based on national origin, race, color, religion, gender, ancestry, age, sexual orientation, gender identity, disability, marital status, veteran status, genetic information or any other status protected by law.”

As an equal opportunity employer, Hanover does not discriminate against qualified individuals with disabilities. Individuals with disabilities who wish to request a reasonable accommodation to participate in the job application or interview process, or to perform essential job functions, should contact us at: and include the link of the job posting in which you are interested.

Privacy Policy:

To view our privacy policy and online privacy statement, click here.

Applicants who are California residents: To see the types of information we may collect from applicants and employees and how we use it, please click here.

Compensation:

The target hiring range for this role may vary based on geographic location and other factors, including merit or performance, demonstrated proficiency, skills for the role, education, travel requirements, and experience. Additional compensation may include an annual bonus (which could take the form of a general bonus, sales incentive, or short-term incentive), long-term incentive or spot recognition awards. The posted range reflects our ability to hire at different position titles and levels depending on background and experience.

Originally posted on Himalayas