Sr. Claims Specialist, Professional Liability | E&O, D&O, EPL | Remote

Sedgwick; Augusta (ME); Remote; USD 100,000 - 125,000; Full time

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

401k and matching

Paid time off (PTO)

Disability and life insurance

Employee assistance program

Flexible spending account / Health SAV

Other voluntary benefits

Job summary

Sedgwick is hiring a Senior Claims Specialist in Professional Liability to work remotely in the United States. You will analyze complex E&O, D&O, and EPL claims, coordinate case management, and manage total claim costs while delivering high levels of service.

The role requires six years of claims management experience, excellent communication and negotiation skills, and proficiency with Microsoft Office. A Bachelor's degree is preferred; professional licensing where applicable is advantageous.

Qualifications

• Bachelor's degree from a college or university preferred.
• Six (6) years of claims management experience or equivalent.
• Excellent oral and written communication; strong negotiation and analytical skills.
• Ability to work in a team environment and meet deadlines.
• PC literate with Microsoft Office proficiency.

Responsibilities

• Analyze and process complex professional liability claims and manage to resolution.
• Conduct full investigations and provide investigation reports.
• Negotiate settlements up to designated authority level.
• Calculate and assign reserves; monitor reserve adequacy.
• Coordinate legal defense and review attorney invoices; ensure client guidelines compliance.
• Identify cost containment opportunities and potential fraud or subrogation cases.
• Represent company in depositions, mediations, and trial monitoring as needed.
• Maintain client relationships and ensure proper documentation of claim files.

Skills

Excellent oral and written

Microsoft Office

Analytical skills

Organizational skills

Negotiation skills

Interpersonal skills

Teamwork

Performance competencies

Education

Bachelor's degree preferred

Professional certification/licensing as applicable

Tools

Microsoft Office

Job description

US Telecommuter

Sr. Claims Specialist, Professional Liability | E&O, D&O, EPL | Remote

PRIMARY PURPOSE

To analyze complex or technically difficult errors and omissions, employment practices law, and directors and officers claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Analyzes and processes complex or technically difficult professional liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.
• Negotiates claim settlement up to designated authority level.
• Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.
• Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.
• Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.
• Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
• Represents Company in depositions, mediations, and trial monitoring as needed.
• Communicates claim activity and processing with the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.
• Delegates work and mentors assigned staff.

ADDITIONAL 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. Licenses as required. Professional certification as applicable to line of business preferred.

Experience

Six (6) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Excellent negotiation skills
• Good 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

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 to $125,000.

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
• 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.

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