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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.

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Senior Claims Negotiator

PRIMARY PURPOSE : Out of Network Negotiators are responsible for evaluating insurance claims, gathering relevant information, and negotiating settlement amounts with providers or their legal representatives, aiming to reach a fair and cost-effective resolution for the payor while adhering to legal guidelines and company policies; this often involves communicating with involved parties, and utilizing negotiation strategies to achieve a mutually agreeable settlement. To act as a subject matter expert by providing information, insight and guidance to the rest of the team on resolution of out of network claims. To ensure consistency in resolving claims through those negotiation methods established and to suggest, assist and establish new methods when needed. To analyze and report on and maintain expected results.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Proactively and strategically manages a complex claim inventory by assessing highly complex claims issues, utilizing jurisdictional expertise, providing oversight, and helping direct the handling to achieve the best possible resolution.

• Assists the claims team as their subject matter expert to assist in addition to lines 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 understand the issues and path to resolution.

• Facilitates and engages appropriate internal and external resources as needed.

• Assists in the evaluation and development of policies and procedures.

• Mentors and provides guidance to the complex claim consultants and complex claim analysts.

• Leads calibration exercises ensuring consistency through the exchange of ideas and strategies.

• ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

Experience

Five(5) years of claims experience or equivalent combination of education and experience required to include two (2) to three (3) years of experience handling complex claims and experience in negotiation, mediation of complex claims. Supervisory experience preferred.

Skills & Knowledge

• Leadership/management/motivational skills

• Analytical and interpretive skills

• Ability to manage claims across multiple jurisdictions

• Excellent oral and written communication skills

• PC literate, including Microsoft Office products

• 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.

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 ( $73,456 - $102,000) . 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.

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.