Complex Claims Advisor | Commercial GL and Auto | Remote

Complex Claims Advisor

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.

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.

Essential Functions and Responsibilities

Proactively and strategically manage 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.

Additional Functions and Responsibilities

Performs other duties as assigned. Supports the organization's quality program(s). Travel 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 as required by law.

Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $100,000 - $110,000 USD annual salary. A comprehensive benefits package is offered including, but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Always accepting applications. 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.