Claims Examiner | Multi-Line | Public Entity | Remote

Claims Examiner | Multi-Line | Public Entity | 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

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? Enjoy flexibility and autonomy in your daily work, your location, and your career path. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Are you an ideal candidate? No day is ever the same assisting our public entity clients with their claims! If you are an agile multi-line examiner with 5+ years of experience handling both 3rd party liability and 1st party property claims, we want to talk to you! This examiner will primarily handle liability for the following lines of coverage : General Liability, Auto Liability, Employment Practices Liability, Law Enforcement Liability and Public Officials Liability. Texas adjuster license is a plus.

Primary Purpose

To analyze complex or technically difficult multi-product line 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 claims by investigating and gathering information to determine the exposure on the claim; assesses damages; manages claims through well-developed action plans to an appropriate and timely resolution.
• Assess and resolve claims within evaluation.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
• Prepares necessary state filings within statutory limits.
• Manages the litigation process; ensures timely and cost effective claims resolution.
• Coordinates vendor referrals for additional investigation and / or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Manages claim recoveries, including but not limited to : subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Secures and disposes of salvage.
• Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
• Communicates claim activity and processing with the claimant, insured, client and agent or broker as appropriate; 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

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 $80,000 to $95,000 USD annual salary. Bonus eligible role. 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.

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.