Sr. Adjuster- Accident Benefits

Sedgwick; Mississauga; On-site; CAD 70,000 - 90,000; Full time

Job summary

Join Sedgwick as a Sr. Adjuster in Accident Benefits, where you will analyze general liability claims to determine benefits due and manage claims. This role requires a Bachelor's degree, four years of relevant experience, and strong negotiation and communication skills. Be part of a great workplace that values employee growth and a supportive culture.

Qualifications

• Four years of claims management experience or equivalent education and experience required.
• Subject matter expert in insurance principles.
• PC literate with good negotiation skills.

Responsibilities

• Manage mid-level general liability claims, including assessing liability and settling claims.
• Communicate claim actions with claimants and clients.
• Ensure proper documentation of claim files and coding.

Skills

Insurance principles and laws

Excellent oral and written communication

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

Education

Bachelor's degree or college diploma

Tools

Microsoft Office

Job description

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

Sr. Adjuster- Accident Benefits

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.

ESSENTIAL FUNCTIONS and 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 FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

• Travels as required .

QUALIFICATIONS

Education & Licensing
Bachelor's degree or college diploma 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

• Excellent oral and written communication

• 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.

We are committed to inclusive, barrier-free recruitment and selection processes. If contacted for an employment opportunity, please advise Colleague Resources if you require accommodation.

Sedgwickis 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.