Claims Adjuster - Casualty

Sedgwick; Canada; Remote; CAD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a dedicated claims analyst to join their team. This role involves analyzing complex general liability claims, negotiating settlements, and ensuring timely resolution while adhering to industry best practices. The ideal candidate will have a strong background in claims management, excellent communication skills, and a passion for making a positive impact. Join a company that values diversity and fosters a supportive work environment, where you can grow your career and contribute to meaningful outcomes for clients and claimants alike.

Qualifications

• 5+ years of claims management experience or equivalent education required.
• Subject matter expert in insurance principles and laws for claims.

Responsibilities

• Analyze and process complex general liability claims.
• Negotiate settlements and manage claims through action plans.

Skills

Insurance Principles

Claims Management

Analytical Skills

Communication Skills

Organizational Skills

Interpersonal Skills

PC Literacy

Education

Bachelor's Degree

Professional Certification

Tools

Microsoft Office

Job description

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.

Great Place to Work

Top 100 Most Loved Workplace

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 by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

Assesses liability and resolves 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.

Reports claims to the excess carrier; responds to requests for directions in a professional and timely manner.

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).

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.

Excellent oral and written communication, including presentation skills.

PC literate, including Microsoft Office products.

Analytical and interpretive skills.

Strong organizational skills.

Good interpersonal skills.

Ability to work in a team environment.

Ability to meet or exceed Service Expectations.

Sedgwick is an Equal Opportunity Employer.

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. Sedgwick retains the discretion to add or to change the duties of the position at any time.