Claims Adjuster I Captive I PD Experience I Remote

Sedgwick; United States; Remote; USD 63,000 - 90,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401k with matching

PTO (Paid Time Off)

Disability and life insurance

Job summary

Sedgwick is seeking a Claims Adjuster I Captive I PD with remote work options in the United States. This role analyzes mid- to high-level general liability claims, determines benefits due, and negotiates settlements within company standards.

You will manage subrogation and maintain client relationships while documenting claims accurately. Qualifications include a bachelor’s degree (preferred) and 4 years of claims management experience, along with strong negotiation, communication, and

Qualifications

• Bachelor's degree preferred.
• 4 years claims management experience required.
• Strong knowledge of insurance principles, laws and subrogation.
• Excellent negotiation and communication skills.
• Analytical and interpretive skills.

Responsibilities

• Manage mid-level general liability claims by gathering information to determine liability exposure, assign reserves, and settle within authority.
• Assess liability and resolve claims within evaluation.
• Approve and process assigned claims, determine benefits due, and manage action plans.
• Manage subrogation of claims and negotiate settlements.
• Communicate claim actions with claimants and clients.
• Ensure claim files are properly documented and claims coding is correct.

Skills

Negotiation

Communication

Analytical skills

MS Office

Education

Bachelor's degree preferred

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 CompaniesCertified as a Great Place to WorkFortune Best Workplaces in Financial Services & InsuranceClaims Adjuster I Captive I PD Experience I RemotePRIMARY 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 RESPONSIBILITIESManages 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 RESPONSIBILITIESPerforms other duties as assigned.Supports the organization's quality program(s).Travels as required.QUALIFICATIONEducation & LicensingBachelor's degree from an accredited college or university preferred.ExperienceFour (4) years of claims management experience or equivalent combination of education and experience required.Skills & KnowledgeSubject 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 skillsPC literate, including Microsoft Office productsAnalytical and interpretive skillsStrong organizational skillsGood interpersonal skillsExcellent negotiation skillsAbility to work in a team environmentAbility to meet or exceed Service ExpectationsWORK ENVIRONMENTWhen 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 deadlinesPhysical: Computer keyboarding, travel as requiredAuditory/Visual : Hearing, vision and talkingThe 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.