By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

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Claims Advisor, Professional Liability

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Analyzes and processes complex or technically difficult liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.Negotiates claim settlement up to designated authority level.Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.Performs coverage analysis and opinion as part of the claim process including all necessary correspondence.Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.Represents company in depositions, mediations, and trial monitoring as needed.Communicates claim activity and processing with the client; maintains professional client relationships.Ensures claim files are properly documented and claims coding is correct.Refers cases as appropriate to supervisor and management.Delegates work and mentors others.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.Travels as required.

QUALIFICATIONS

Education & Licensing

Masters or Juris Doctorate degree from an accredited college or university preferred.  Licenses as required.  Designations and/or licensing including but not limited to Bachelor of Science in Nursing, Legal Nurse Consultant, Associate in Claims (AIC), Chartered Property and Casualty Underwriter (CPCU), Associate in Risk Management (ARM), Associate in Insurance Claims (AIC), Certified Professional in Health Care Risk Management (CPHRM) preferred.

Experience
Ten (10) years of complex claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-businessExtensive knowledge and comprehension of insurance coverageClaims expertise in medical malpractice, errors and omissions, directors and officers, life sciences, and/or cyber liabilityExcellent oral and written communication, including presentation skillsPC literate, including Microsoft Office productsAnalytical and interpretive skillsStrong organizational skillsExcellent negotiation skillsGood interpersonal skillsAbility to work in a team environmentAbility to meet or exceed Performance Competencies

WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental:  Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical:  Computer keyboarding, travel as required

Auditory/Visual:  Hearing, vision and talking 

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.  They are not intended to constitute a comprehensive list of functions, duties, or local variances.  Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.