Talent.com
Complex Claims Advisor

Complex Claims Advisor

SedgwickSun Prairie, WI, US
job_description.job_card.30_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
job_description.job_card.job_description

Complex Claims Advisor

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work Most Loved Workplace Forbes Best-in-State Employer

Primary Purpose : To develop targeted solutions and provide added technical guidance and oversight to ensure matters are resolved optimally while creating a culture of continual quality improvement designed to elevate the overall claim handling to benefit our stakeholders.

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.
  • 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).
  • Travels 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 maintain appropriate 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

    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.

    serp_jobs.job_alerts.create_a_job

    Claim • Sun Prairie, WI, US

    Job_description.internal_linking.related_jobs
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Healthcare Claims Analyst

    Healthcare Claims Analyst

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for a Claims Analyst (Healthcare) to support their team in a remote capacity.Key Responsibilities Research, resolve, and follow up on rejected or unpaid pharmacy claims for a...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    Claims Processor

    Claims Processor

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for a Claims Processor LPO.Key Responsibilities Identifies coverage, sets up new claims, and assigns appropriate personnel Documents claims and handles incoming corresponden...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Manager of Tech - Claims

    Manager of Tech - Claims

    MedicaMadison, WI, United States
    serp_jobs.job_card.full_time
    Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences an...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Lead Claims Coordinator

    Lead Claims Coordinator

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for a Lead Claims Services Coordinator.Key Responsibilities Act as the main client contact for all claims systems inquiries and reporting Prepare daily reports of expiring c...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    Claims Director

    Claims Director

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for a Claims Director to oversee claims administration policies and procedures.Key Responsibilities Oversee claims administration policies and ensure appropriate payments Co...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Claims Examiner

    Claims Examiner

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for a Claims Examiner I.Key Responsibilities Process and adjudicate healthcare claims, including medical, dental, vision, and mental health claims Conduct claims investigati...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Indemnity Claims Specialist

    Indemnity Claims Specialist

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for an Indemnity Claims Specialist (remote).Key Responsibilities Receives claims, confirms policy coverage, and acknowledges the claim Determines validity and compensability...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Claims Adjuster

    Claims Adjuster

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for a Claims Adjuster, Tire Operations, L1.Key Responsibilities Process claims accurately and in a timely manner while adhering to established guidelines Handle inquiries fr...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    NC & SC Licensed Claims Adjuster

    NC & SC Licensed Claims Adjuster

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for a Workers Compensation Claims Adjuster with NC & SC jurisdictional knowledge preferred.Key Responsibilities Analyze and process claims to achieve timely resolutions throu...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Claims Escalation Specialist

    Claims Escalation Specialist

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for a Claims Escalation Specialist responsible for reviewing and processing healthcare claims and escalations. Key Responsibilities Review and analyze healthcare claims to ens...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    Claims Supervisor

    Claims Supervisor

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for a Claims Supervisor to lead a team of Claims Processors and ensure accurate claims processing for employer-sponsored health plans. Key Responsibilities Oversee claims proc...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Insurance Solutions Advisor

    Insurance Solutions Advisor

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for an Insurance Discovery Solutions Advisor.Key Responsibilities Manage the performance of a client portfolio for a contingency-based insurance discovery solution, focusing ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Virtual Total Loss Adjuster

    Virtual Total Loss Adjuster

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for an Obvious Total Loss Virtual Adjuster.Key Responsibilities Manage total loss claims by reviewing claim details and preparing total loss valuations Assess vehicle condit...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    Claim Specialist- Property Field Inspection

    Claim Specialist- Property Field Inspection

    State Farm Mutual Automobile Insurance CompanyMadison, WI, United States
    serp_jobs.job_card.full_time
    Claim Specialist- Property Field Inspection.Build your career at one of the top companies for professional growth in the U. At State Farm we invest in our employees by providing a competitive Total ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Auto Property Damage Claims Trainer

    Auto Property Damage Claims Trainer

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for an Auto Property Damage Claims Trainer to design and deliver training programs for auto claims adjusters. Key Responsibilities Develop and deliver structured training prog...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    Remote Claims Specialist

    Remote Claims Specialist

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    A company is looking for a Remote Claims Specialist.Key Responsibilities Review and investigate claims related to FMLA, PFL, ADA, and other leave programs Adjudicate claims in accordance with re...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_days
    • serp_jobs.job_card.promoted
    Senior General Liability Adjuster

    Senior General Liability Adjuster

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for a Senior General Liability Claims Adjuster.Key Responsibilities Analyze claims exposure and execute decision-making to resolve claims effectively Interact with various p...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    State Licensed Senior Claims Adjuster

    State Licensed Senior Claims Adjuster

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for a Senior Claims Adjuster - Premises, Slip and Fall / Restaurant and Retail.Key Responsibilities Investigate, evaluate, and resolve complex commercial general liability clai...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Remote Insurance Claims Collector

    Remote Insurance Claims Collector

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    A company is looking for a Remote Insurance Claims Collector.Key Responsibilities Work with insurance companies to determine the cause of denial or non-payment of a claim Initiate appropriate ac...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Healthcare Claims Operations Supervisor

    Healthcare Claims Operations Supervisor

    VirtualVocationsMadison, Wisconsin, United States
    serp_jobs.job_card.full_time
    A company is looking for a Service Operations Supervisor in the Healthcare Claims Department.Key Responsibilities Oversee daily tasks and workflow of a team of associates, ensuring quality manage...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours