Claims Adjuster Liablity

Sedgwick Claims Management Services Ltd; Georgia; Híbrido; USD 65.000 - 90.000; Jornada completa

Descripción de la vacante

Sedgwick Claims Management Services Ltd is seeking an experienced General Liability Claims Manager to analyze mid- and high-level claims, determine benefits due, and adjudicate within company standards and industry best practices. You will manage subrogation, negotiate settlements, and communicate with claimants and clients.

Requires a Bachelor's degree (preferred) and four years of claims management experience. Strong negotiation, analytical, and MS Office skills are essential.

Formación

• Bachelor's degree preferred.
• Four (4) years of claims management experience or equivalent.
• Subject matter expert of insurance principles and laws for line-of-business handled.

Responsabilidades

• Manage mid-level general liability claims by gathering information to determine liability exposure.
• Assign reserve values and make claims payments as necessary; settle claims within authority level.
• Assess liability and resolve claims within evaluation; approve and process assigned claims.
• Manage subrogation of claims and negotiate settlements.
• Communicate claim action with claimant and client; document files and ensure coding is correct.
• Travel as required and support quality programs.

Conocimientos

Negotiation

Analytical skills

Organizational skills

Interpersonal skills

Oral and written communication

MS Office

Teamwork

Service orientation

Educación

Bachelor's degree

Herramientas

Microsoft Office

Descripción del empleo

**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 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.Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.