Claims examiner Jobs in Toledo oh

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Auto Liability Bodily Injury Claims Examiner

PRIMARY PURPOSE : To analyze and process complex auto and commercial transportation bodily injury claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.

Responsible for litigation process on litigated claims.

Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.

Reports large claims to excess carrier(s).

Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.

Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.

Communicates claim action / processing with insured, client, and agent or broker when appropriate.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.

Supports the organization's quality program(s).

Travels as required.

QUALIFICATIONS

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position.

Experience

Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage’s, principles, and laws.

Skills & Knowledge

In-depth knowledge of personal and commercial line auto policies, coverage’s, principles, and laws

Knowledge of medical terminology for claim evaluation and Medicare compliance

Knowledge of appropriate application for deductibles, sub-limits, SIR’s, carrier and large deductible programs.

Strong oral and written communication, including presentation skills

PC literate, including Microsoft Office products

Strong organizational skills

Strong interpersonal skills

Good 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

NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.

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.

Pay Transparency :

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 $70,000. 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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us. ()