Claims Advisor, Professional Liability | E&O, D&O

Sedgwick

5d•$115,000 - $130,000•Onsite

About The Position

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 PRIMARY PURPOSE OF THE ROLE: Manage and handle executive, error and omissions, and complex professional 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.

Requirements

Ten (10) years of complex claims management experience or equivalent combination of education and experience required
Licenses as required.
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
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
Computer keyboarding
Hearing, vision and talking
Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

Nice To Haves

Masters or Juris Doctorate degree from an accredited college or university preferred.
Designations and/or licensing including but not limited to 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.

Responsibilities

Analyzes and processes complex or technically difficult liability claims by investigating to determine the exposure on the claim
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
Recommends settlement strategies
Performs coverage analysis and opinion as part of the claim process
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
Ensures claim files are properly documented and claims coding is correct.
Refers cases as appropriate to supervisor and management.