Complex Claims Advisor | Commercial GL and Auto | Remote

Sedgwick; Atlanta (GA); Remote; USD 100,000 - 110,000; Full time

Job summary

A global claims administration leader is seeking a Complex Claims Advisor to support insurance carriers with evaluating claims and drafting other technical documentation. The ideal candidate will have extensive experience in insurance coverage analysis and a passion for detail-oriented work. This role is remote and offers competitive pay, along with a comprehensive benefits package including medical, dental, and more.

Benefits

Comprehensive benefits package

Flexible work environment

Competitive salary

Qualifications

• Eight years of casualty claims experience required.
• Experience handling complex claims and negotiation skills required.
• Supervisory experience is a plus.

Responsibilities

• Manage a complex claim inventory.
• Provide guidance on complex claims issues.
• Draft coverage opinions and Reservation of Rights letters.

Skills

Expertise in insurance coverage analysis

Analytical skills

Excellent written communication

Negotiation and mediation skills

Education

Bachelor's degree

Tools

Microsoft Office

Job description

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 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 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 demonstratedexpertise 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 maintainappropriate 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, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. 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.

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.

#LI-REMOTE

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.

Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com