Complex Claims Advisor | Commercial GL and Auto | Remote

Sedgwick•Austin, TX

6d•$100,000 - $110,000•Remote

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 Complex Claims Advisor | Commercial GL and Auto | Remote Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands? Enjoy flexibility and autonomy in your daily work, your location, and your career path. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ARE YOU AN IDEAL CANDIDATE? Are you an experienced attorney or examiner with a strong background in insurance coverage analysis? We’re seeking an experienced attorney or senior level examiner with a strong background in insurance coverage analysis to support insurance carriers by evaluating claims and loss complaints, interpreting policy language, and drafting Reservation of Rights and disclaimer letters. This role offers the opportunity to apply your expertise in commercial general liability and auto policies, endorsements, exclusions, and litigation support, while delivering clear, actionable coverage opinions and collaborating with claims professionals and managers. If you thrive in a detail-oriented, analytical environment and have a passion for coverage law, we’d love to hear from you. Experience in claims handling or underwriting is a strong plus. PRIMARY PURPOSE: To develop targeted solutions and provide added technical guidance and oversight. To evaluate insurance claims and loss complaints for coverage applicability, draft Reservation of Rights and disclaimer letters, and provide expert coverage opinions to insurance carriers. This role supports litigation and policy interpretation ensuring accurate and timely guidance on complex coverage issues.

Requirements

Bachelor's degree from an accredited college or university preferred.
Industry designation(s) preferred.
Licenses as required for specific jurisdictions.
Eight (8) years of casualty claims experience or equivalent combination of education and experience required to include three (3) to five (5) years of experience handling complex claims and experience in negotiation, mediation, arbitration or ADR skills on higher value complex claims.
Supervisory experience a plus.
Specific jurisdictional expertise preferred.
Subject matter expertise in worker’s compensation claims and/or liability claims processing
Ability to obtain and maintain appropriate licensing
Ability to manage claims across multiple jurisdictions
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Excellent analytical and interpretive skills
Strong organizational skills
Ability to work in a team environment
Ability to meet or exceed Service Expectations

Nice To Haves

Experience in claims handling or underwriting is a strong plus.

Responsibilities

Proactively and strategically manages a complex claim inventory by assessing complex claims issues, utilizing jurisdictional expertise to provide oversight, and directs the handling to achieve the best possible resolution.
Acts as the organizational subject matter expert for line of business and key jurisdictions on complex claim issues.
Uses knowledge of all aspects of claims handling in evaluating exposure; recommends and directs action plans for issue or case resolution.
Articulates and documents clear and concise file notes to allow stakeholders to understand the issues and path to resolution.
Ability to clearly and effectively communicate complex coverage analyses to clients, claim examiners, and managers, translating technical policy language into actionable insights.
Exceptional written communication skills with demonstrated expertise in drafting clear, accurate coverage disclaimers and Reservation of Rights letters.
Facilitates roundtables with groups/teams; engages appropriate internal and external resources as needed.
Provides technical leadership on and maintains co-ownership of complex claim issues; through further influence creates a culture of continual quality improvement.
Performs other duties as assigned.
Supports the organization's quality program(s).
Travel as required.