Complex Claims Advisor - Sedgwick Claims Management Services, Inc.

PRIMARY PURPOSE: To develop targeted solutions and provide added technical guidance and oversight to ensure matters are resolved optimally while creating a culture of continual quality improvement designed to elevate the overall claim handling to benefit our stakeholders.

ESSENTIAL FUNCTIONS and 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.
• 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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

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

QUALIFICATION

Education & Licensing
Bachelor's degree from an accredited college or university preferred. Industry designation(s) preferred. Licenses as required for specific jurisdictions.

Experience
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.

Skills & Knowledge

• 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

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.

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.