Claims Adjuster I Captive I PD Experience I Remote

Sedgwick; Oregon; Hybrid; USD 63,000 - 90,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401k matching

Paid time off

Disability insurance

Life insurance

Employee assistance

Job summary

Sedgwick in Oregon seeks an experienced claims professional to analyze mid- to high-level general liability claims, determine benefits due, and advocate for fair settlements. You will manage reserve values, approve payments, and coordinate subrogation under client contracts.

The role emphasizes strong communication, negotiation, and analytical skills; a bachelor’s degree and four years of claims management experience are preferred, with a comprehensive benefits package and opportunities for

Qualifications

• Bachelor's degree preferred.
• Four (4) years claims management experience or equivalent.
• Subject matter expert in insurance principles, laws, recoveries, deductions, and Medicare/SS procedures.
• Excellent oral and written communication including presentation skills.

Responsibilities

• Analyze mid- to higher-level general liability claims to determine benefits due.
• Assign reserve values and process payments; settle claims within authority.
• Assess liability and resolve claims within evaluation.
• Approve and process assigned claims per client contracts.
• Manage subrogation and negotiate settlements.

Skills

Communication

Negotiation

Analytical

Organization

Interpersonal skills

Presentation skills

Education

Bachelor's degree

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.

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.

QUALIFICATION

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.

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

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. 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 $63,404 - $90,000/yr. 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.

Always accepting applications.

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.