Claims Adjuster - Liability

Sedgwick; Kawartha Lakes; On-site; CAD 60,000 - 80,000; Full time

Job summary

A leading claims management provider in Kawartha Lakes seeks a Claims Manager to analyze mid- and higher-level general liability claims. The ideal candidate will have a Bachelor’s degree and 4+ years of claims management experience. Responsibilities include managing claims, communicating with clients, and ensuring accurate documentation. Join a company recognized for its workplace culture and grow your career in an environment that values work-life balance.

Qualifications

• 4 years of claims management experience or equivalent combination of education and experience.

Responsibilities

• Manage mid-level general liability claims by gathering information to determine liability exposure.
• Ensure claims are properly documented and correctly coded.
• Negotiate settlements and maintain professional client relationships.

Skills

Expertise in insurance principles

Excellent communication skills

Analytical skills

Organizational skills

Negotiation skills

Teamwork ability

Education

Bachelor's degree

Tools

Microsoft Office

Job description

Overview

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 mid- and higher-level general liability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

Responsibilities

• Manages mid-level general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
• Assesses liability and resolves claims within evaluation.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

Additional 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.

Experience

Four (4) 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

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.