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

Sedgwick•Telecommuter FL, NV

3d•$115,000 - $130,000

About The Position

The Claims Advisor manages complex or technically difficult professional liability claims, including directors and officers (D&O), employment practices liability (EPL), errors and omissions (E&O), and/or cyber liability claims. The role investigates claims, evaluates exposure and coverage, develops action plans, establishes and monitors reserves, negotiates settlements, and works toward appropriate and timely resolution. It also coordinates legal defense, communicates with clients, and identifies opportunities to control or recover claim costs. The Claims Advisor may represent the company in depositions, mediations, and trial monitoring; ensure files and coding are accurate; refer cases to management when appropriate; and delegate work and mentor others. The role requires computer keyboarding and the ability to meet deadlines while exercising clear judgment and discretion. Sedgwick describes its culture as caring and highlights work-life balance. Compensation for the jurisdiction specified in the posting is $115,000–$130,000, with a comprehensive benefits package.

Requirements

Ten years of complex claims management experience, or an equivalent combination of education and experience.
Licenses as required.
In-depth knowledge of applicable insurance principles and laws for the line of business handled, recoveries, offsets and deductions, claim and disability duration, and cost-containment principles, including medical management practices and Social Security application procedures as applicable.
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 and presentation skills.
PC literacy, 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.
Ability to perform computer keyboarding and meet the role’s auditory, visual, and communication demands.
Clear and conceptual thinking, excellent judgment and discretion, and ability to meet deadlines.

Nice To Haves

Master’s or Juris Doctorate degree from an accredited college or university.
Professional designations and/or licensing such as Associate in Claims (AIC), Chartered Property and Casualty Underwriter (CPCU), Associate in Risk Management (ARM), or Associate in Insurance Claims (AIC).

Responsibilities

Investigate and process complex or technically difficult D&O, EPL, and E&O liability claims, gathering information to determine claim exposure.
Manage claims through well-developed action plans toward appropriate and timely resolution.
Conduct or assign full investigations and prepare reports concerning new events, claims, and legal actions.
Negotiate claim settlements up to the designated authority level.
Calculate and assign timely, appropriate reserves, and monitor reserve adequacy throughout the life of each claim.
Recommend settlement strategies and develop structured settlement proposals when appropriate.
Perform coverage analysis and provide opinions, including necessary correspondence.
Coordinate legal defense by assigning attorneys, supporting investigations, reviewing attorney invoices, and monitoring counsel for compliance with client guidelines.
Use cost-containment techniques, including strategic vendor partnerships, to reduce claim costs.
Identify and investigate potential fraud, subrogation, contribution, recovery, and case-management opportunities to reduce total claim costs.
Represent the company in depositions and mediations and monitor trials as needed.
Communicate claim activity and processing to clients and maintain professional client relationships.
Ensure claim files are properly documented and claim coding is correct.
Refer cases to supervisors and management as appropriate.
Delegate work and mentor others.