Claim Advisor, Professional Liability (Cyber) - Sedgwick Claims Management Services, Inc.

PRIMARY PURPOSE: To analyze complex or technically difficult Cyber and other Professional Liability claims; to provide resolution of medium to highly complex nature claims; to perform 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

Claims Management and Processing:

• Handle a diverse portfolio of cyber claims, including various Professional Liability claims, for various insurance company clients
• Conduct comprehensive investigations into incidents, including data breaches, ransomware attacks, and business interruption claims
• Analyze policy wordings and determine coverage applicability for each claim
• Draft coverage letter
• Maintain accurate claim files and documentation in compliance with client-specific guidelines and regulatory requirements
• Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.

Client Relations:

• Serve as the primary point of contact for assigned insurance company clients
• Provide regular updates and reports to clients on claim status, trends, and potential high-exposure cases
• Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.
• Represents Company in depositions, mediations, and trial monitoring as needed.

Vendor Management:

• Coordinate with and oversee external vendors, including forensic experts and legal counsel
• Manage vendor expenses and ensure adherence to client-specific billing guidelines
• Evaluate vendor performance and make recommendations for the vendor panel

Technical Expertise:

• Stay current with evolving cyber threats, industry trends, and best practices in cybersecurity
• Provide technical guidance to less experienced team members on complex cyber claims

Reporting and Analytics:

• Prepare detailed claim reports and analyses for insurance company
• Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.
• Refers cases as appropriate to supervisor and management.

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

Experience
At least six (6) years of claims management experience, with at least three (3) years of cyber claims management experience, or equivalent combination of education and experience required.

Skills & Knowledge

• In-depth knowledge of appropriate Cyber and other Professional Liability lines, including E&O, D&O, EPL, etc. insurance principles and laws for line-of-business handled, cost containment principles and procedures as applicable to line-of-business
• 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 

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.  A writing sample (a redacted coverage letter) is also requested.

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 $120,000- $130,000. 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, and other additional voluntary benefits.