Apply on Employer Site

Sedgwick · 2 months ago

Management & Executive Risk Claims Manager

United States

Full-time

Remote

Senior Level, Lead/Staff

10+ years exp

Sedgwick is a leading claims management services provider, recognized for its commitment to a caring culture and work-life balance. The Management & Executive Risk Claims Manager will analyze and process complex liability claims, negotiate settlements, and coordinate legal defenses, ensuring timely resolution and client communication.

BankingInsuranceRisk Management

Responsibilities

Analyzes and processes complex or technically difficult 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

Performs coverage analysis and opinion as part of the claim process including all necessary correspondence

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 others

Performs other duties as assigned

Travels as required

Qualification

Claims management experienceMedical malpractice knowledgeInsurance coverage expertiseAnalytical skillsNegotiation skillsPC literacyOral communicationWritten communicationOrganizational skillsInterpersonal skillsTeamwork

Required

Ten (10) years of complex claims management experience or equivalent combination of education and experience required

In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business

Extensive knowledge and comprehension of insurance coverage

Claims expertise in medical malpractice, errors and omissions, directors and officers, life sciences, and/or cyber liability

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

Preferred

Masters or Juris Doctorate degree from an accredited college or university preferred

Licenses as required

Designations and/or licensing including but not limited to Bachelor of Science in Nursing, Legal Nurse Consultant, Associate in Claims (AIC), Chartered Property and Casualty Underwriter (CPCU), Associate in Risk Management (ARM), Associate in Insurance Claims (AIC), Certified Professional in Health Care Risk Management (CPHRM) preferred