Claims Advisor - Complex Property & Excess Recovery - Sedgwick Claims Management Services, Inc.

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Claims Advisor - Complex Property & Excess Recovery

PRIMARY PURPOSE:  Manages large property losses for Pooling, including direct handling of complex property losses of all types with no limit on dollar threshold, including in excess of $1,000,000.  Oversees all property claims management review (CMR) reports from the underlying field offices; identifies, reports, and manages large and catastrophic loss events to reinsurance and completes detailed property board reports for Pooling clients.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Examines claim forms, policies (certificates), coverage extensions, endorsements, and other records to determine applicable insurance coverage.
• Consults with underwriting on coverage concerns and policy interpretation as needed.
• Interviews, telephones, and corresponds with members and witnesses regarding claims.
• Consults police and hospital records, inspects property damage to determine extent of company's liability, and uses varying methods of investigation according to type of insurance.
• Determines the necessity of and reviews technical reports from specialty vendors, including but not limited to cause and origin experts, engineers, large equipment specialists, and other specialists for claims investigation purposes.
• Estimates cost of repair, replacement, or compensation.
• Prepares report of findings, confirms management and accounting approval, and negotiates settlement with the Pool Member.
• Recommends litigation when settlement cannot be negotiated; attends litigation hearings.
• Works with field offices on assigned files to determine adequate reserves and oversight, as needed; assist the field office handlers with various questions.
• Completes subrogation activities to conclusion by consulting with and retaining legal staff as needed for the pursuit of subrogation.
• Monitors new and existing catastrophic losses to determine reportability.
• Reviews applicable excess policies for coverage, retention threshold, and reporting requirements.
• Reports, administers, and reconciles complex catastrophic claims for property losses for all pools.
• Interacts with excess carriers to determine coverages, excess insurance levels, and potential reimbursements.
• Submits the required documentation to the reinsurers as required by their management.
• Completes, reviews, and performs follow-up as needed for the life of the claim for claims reported by the field office adjusters.
• Reports claim file handling issues to the corresponding manager as needed to address and resolve problems.
• Identifies and corrects all claim concerns within field adjuster claim files while reviewing files during the board reporting process.
• Completes Excess reporting for claims that meet reporting requirements that remain handled by the field office adjusters.
• Researches individual claims that meet the reporting threshold.
• Prepares financial data and ensures accuracy of report data.
• Prepares narrative reports for claims that meet board reporting requirements and completes updates for individual claims.
• Ensures timely completion of all required board forms.
• Identifies issues concerning inconsistent financials of the board reports and report to the applicable management, as needed.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Travel as required.

QUALIFICATIONS

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Must have earned the IIA-AIC designation and be actively pursuing another professional insurance designation.  Appropriate state adjuster license is required.

Experience

Eight (8) years of related experience or equivalent combination of education and experience required. Applicable experience must include direct handling of complex and large loss claims (in excess of $100,000), and preferred experience with multiple types of property claims, including commercial property, automobile, and heavy equipment.

Skills & Knowledge

• Extensive knowledge of investigative practices
• Ability to analyze complex reports, concepts, and data
• Strong problem-solving skills
• Knowledge of claims law, liability concepts, and applicable property damage law concepts for subrogation purposes
• Knowledge of basic building practices and construction terminology
• Excellent oral and written communication skills, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Excellent negotiating skills
• Ability to create and complete comprehensive, accurate and constructive written reports
• 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

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.