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: To manage claim caseload of highly complex claims, coverage issues (handling claims against insurance or other companies related to personal, casualty, or property loss of at least $1million) and complex litigation within granted authority level including related financial implications, along with financial implications and to mentor other team members.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Manages claim caseloads involving complex coverage issues with specific loss such as discontinuing business expense.
• Handles claims of at least one million dollars and that involve multiple buildings.
• Utilizes special account instructions to obtain individual customer information and adhere to instructions; identifies, initiates, and coordinates various specialized services such as subrogation, fraud evaluation or case management review to resolve claims.
• Establishes and maintains effective relationship with internal and external customers and internal colleagues; communicates effectively and timely.
• Mentors and coaches account representatives and account specialists; facilitates round table discussions within the assigned team.
• Investigates, evaluates, and resolves claims; identifies potential problems/trends in claim files and takes corrective action or makes corrective recommendations; interprets medical reports and state law or jurisdictional law in claim handling.
• Applies jurisdictional and medical knowledge to properly assess the indemnity, medical and expense exposure of assigned claims and appropriately interprets and applies insurance coverage.
• Reviews client files and collaborates with team to prepare information which includes thorough analysis of file strategies, claims status and emerging trends.
• Proactively manages litigation in conjunction with client requirements; works constructively with client and legal representatives to resolve complex litigated claims.
• Ensures compliance and best possible outcomes by minimizing financial liability.
• Complies with all statutory guidelines and individual licensing requirements in order to prevent penalties and fines; utilizes instructions and tools provided to ensure that all state required documentation is issued accurately and in timely manner in accordance with specific jurisdictional timeframes and guidelines. 
• Monitors reports as assigned and documents compliance with key jurisdictional requirements (i.e. EDI, timeliness of benefit payments, etc.); assists Team Lead in tracking completion of team’s tasks and projects; reviews SAS/SOX documents and submits in timely manner; and assists with takeover and reverse takeover projects ensuring that claim files are transferred and handled appropriately.

ADDITIONAL ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing
Bachelor's degree from an accredited college or university preferred. State adjuster licenses required.

Experience
Eight (8) years of related experience or equivalent combination of experience and education required.

Skills & Knowledge

• Thorough legal and jurisdictional knowledge based on line of business
• Strong oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Strong Customer Service skills
• Excellent 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

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.