Claim Examiner - Liability | Remote

Claim Examiner - Liability | Remote

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance

Primary Purpose

To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

Essential Functions and Responsibilities

Analyzes and processes complex or technically difficult general liability claims; assesses liability and resolves claims within evaluation; negotiates settlement of claims; calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim; calculates and pays benefits due; prepares necessary state filings; manages the litigation process; coordinates vendor referrals; uses appropriate cost containment techniques; manages claim recoveries; reports claims to the excess carrier; communicates claim activity and processing with the claimant and the client; maintains professional client relationships; ensures claim files are properly documented and claims coding is correct; refers cases as appropriate to supervisor and management.

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. Professional certification as applicable to line of business preferred.

Experience : Five (5) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge : Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application 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. Good interpersonal skills. Excellent negotiation 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 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 $85,000 - $95,000 / yr. 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.