Claims Advisor - Professional Liability (REMOTE)
Company: Sedgwick
Location: Tallahassee
Posted on: September 15, 2023
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Job Description:
Taking care of people is at the heart of everything we do, and
we start by taking care of you, our valued colleague. A career at
Sedgwick means experiencing our culture of caring. It means having
flexibility and time for all the things that are important to you.
It's an opportunity to do something meaningful, each and every day.
It's having support for your mental, physical, financial and
professional needs. It means sharpening your skills and growing
your career. And it means working in an environment that celebrates
diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a
positive impact on the world through the people and organizations
we serve. If you are someone who is driven to make a difference,
who enjoys a challenge and above all, if you're someone who cares,
there's a place for you here. Join us and contribute to Sedgwick
being a great place to work.
Great Place to Work -
Most Loved Workplace -
Forbes Best-in-State Employer
Claims Advisor - Professional Liability (REMOTE)
executive, cyber, professional liability, error and omissions, and
complex liability claims; to provide resolution of highly complex
nature and/or severe injury claims; to coordinate case management
within company standards, industry best practices and specific
client service requirements; and to manage the total claim costs
while providing high levels of customer service.
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-business
Extensive knowledge and comprehension of insurance coverage
Claims expertise in medical malpractice, errors and omissions,
directors and officers, life sciences, 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
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
NOTE : Credit security clearance, confirmed via a background credit
check, is required for this position.
As required by law, Sedgwick provides a reasonable range of
compensation for roles that may be hired in jurisdictions requiring
pay transparency in job postings. Actual compensation is influenced
by a wide range of factors including but not limited to skill set,
level of experience, and cost of specific location. For the
jurisdiction noted in this job posting only, the range of starting
pay for this role is $76,630 - 107,282 USD annually. A
comprehensive benefits package is offered including but not limited
to, medical, dental, vision, 401k and matching, PTO, disability and
life insurance, employee assistance, flexible spending or health
savings account, and other additional voluntary benefits
#LI-REMOTE #claimsexaminer
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.
Taking care of people is at the heart of everything we do. Caring
counts
Sedgwick is a leading global provider of technology-enabled risk,
benefits and integrated business solutions. Every day, in every
time zone, the most well-known and respected organizations place
their trust in us to help their employees regain health and
productivity, guide their consumers through the claims process,
protect their brand and minimize business interruptions. Our more
than 30,000 colleagues across 80 countries embrace our shared
purpose and values as they demonstrate what it means to work for an
organization committed to doing the right thing - one where caring
counts. Watch this video to learn more about us.
(https://www.youtube.com/watch?v=ywxedjBGSfA)
Keywords: Sedgwick, Tallahassee , Claims Advisor - Professional Liability (REMOTE), Other , Tallahassee, Florida
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