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About the Role
Sedgwick is seeking a Claims Advisor specializing in Professional Liability (E&O, D&O) to analyze and process complex claims, manage investigations, negotiate settlements, and ensure appropriate claim resolution. Join a company recognized for its caring culture and work-life balance, offering opportunities for career growth.
Responsibilities
- Analyzes and processes complex or technically difficult D&O, EPL and E&O 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.
Requirements
- Ten (10) years of complex claims management experience or equivalent combination of education and experience required.
- Licenses as required.
- Work environment requirements include computer keyboarding, hearing, vision, talking, clear and conceptual thinking ability, excellent judgement and discretion, and ability to meet deadlines.
Skills
- 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-business
- Extensive knowledge and comprehension of insurance coverage
- Claims expertise in errors and omissions, directors and officers,, and/or cyber liability
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skills
- Excellent negotiation skills
- Good interpersonal skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
Experience Level
- Ten (10) years of complex claims management experience
Education Level
- Masters or Juris Doctorate degree from an accredited college or university preferred.
- Associate in Claims (AIC), Chartered Property and Casualty Underwriter (CPCU), Associate in Risk Management (ARM), Associate in Insurance Claims (AIC) preferred.
Salary/Compensations
- $115,000 to $130,000
Benefits
- Medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
About the Company
- 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.
- Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
- Certified as a Great Place to Work®
- Fortune Best Workplaces in Financial Services & Insurance
Equal Opportunity
- Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
- 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.