Claims Adjuster I Captive I PD Experience I Remote

Sedgwick Claims Management Services Inc.; United States; Remote; USD 63,000 - 90,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401k with match

Paid time off

Disability insurance

Life insurance

Employee assistance program

FSA / HSA

Job summary

Sedgwick Claims Management Services Ltd is seeking a Claims Adjuster I to analyze mid- and higher-level general liability claims and determine benefits due. You will ensure adjudication aligns with company standards and industry best practices while identifying subrogation and negotiating settlements.

The role requires evaluating liability, assigning reserves, and processing claims up to authorized levels, with a focus on professional client relationships and accuracy in documentation.

Qualifications

• Education & Licensing Bachelor's degree from an accredited college or university preferred
• Four (4) years of claims management experience or equivalent combination of education and experience required

Responsibilities

• Manages mid-level general liability claims by gathering information to determine liability exposure
• Assigns reserve values to claims, makes claims payments as necessary, and settles claims up to designated authority level
• Assesses liability and resolves claims within evaluation
• Approves and processes assigned claims, determines benefits due, and manages action plans
• 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 including state and physician filings and decisions on treatments recommended by utilization review
• Maintains professional client relationships

Skills

Communication skills

Negotiation skills

Analytical thinking

Microsoft Office

Team collaboration

Claims knowledge

Education

Bachelor's degree

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 Claims Adjuster I Captive I PD Experience I Remote

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.

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.

Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

For more, see sedgwick.com