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Role Description

Performs comprehensive reviews on personal and commercial lines claims of varying degree of severity (up to approximately $300,000) to ensure the highest quality of work product is delivered to our clients; confirm our adjuster’s claim files comply with specific client handling guidelines and company standards; and identifies trends in non-compliance to recommend training opportunities that exist.

Essential Functions and Responsibilities

• Executes the quality assurance program by completing quality reviews of Personal and Commercial Lines claim files using Xactimate and Symbility.
• Interprets policy and client guidelines on personal and commercial lines claims to ensure compliance.
• Guides field colleagues on revisions as required to ensure compliance with client guidelines and company standards.
• Completes revisions as required via Xactimate and/or Symbility as appropriate.
• Documents review findings in accordance with team processes.
• Identifies and provides training and improvement opportunities to the Team Lead to meet established operational and technical audit requirements.
• Coordinates with the Analyst Team in implementing Sedgwick business unit (SBU) and national quality initiatives at the local and/or SBU level.
• Provides feedback to the Team Lead to contribute to the performance management review meetings and group training, as needed.
• Maintains technical claims handling and estimating and jurisdictional expertise.

Additional Functions and Responsibilities

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

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Must be eligible to be a licensed All-Lines adjuster.
• Completion of industry-related training course(s) preferred.
• Five (5) years of related experience, including three (3) years of claims handling at an advanced technical level as a file reviewer of personal and commercial claims, or equivalent combination of education and experience required.
• Strong knowledge of claims handling and file review practices and procedures.
• Versed in quality and auditing processes.
• Proficient in electronic estimating using Xactimate or Symbility.
• Excellent oral and written communication skills, including presentation skills.
• PC literate, including Microsoft Office products and digital resources.
• Analytical and interpretive skills.
• Strong organizational skills.
• Ability to learn how to navigate virtual meeting, screen sharing, and collaboration applications.
• Self-motivated with an ability to thrive in a remote work environment.
• Excellent interpersonal 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

• 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.