Claims Adjuster Liablity

Sedgwick; New York (NY); On-site; USD 70,000 - 110,000; Full time

Job summary

Sedgwick in New York seeks a mid- to senior-level Claims Adjuster to analyze general liability claims, determine benefits due, and manage subrogation and settlements within authority limits.

The role emphasizes strong communication, analytical skills, and teamwork; requires 4 years of claims experience and a bachelor’s degree preferred; excellent negotiation and client relations building.

Qualifications

• Bachelor's degree preferred.
• Four years of claims management experience or equivalent.
• Strong communication, presentation and writing skills.
• Proficiency with Microsoft Office and claim management systems.

Responsibilities

• Analyze mid- to high-level general liability claims and determine benefits due.
• Assign reserves, authorize payments, and settle claims within authority.
• Assess liability, manage subrogation, and negotiate settlements.
• Communicate claim actions to claimants and clients; maintain documentation.
• Support quality programs and maintain professional client relationships.

Skills

Oral and written communication

MS Office proficiency

Analytical skills

Organizational skills

Interpersonal skills

Negotiation skills

Teamwork

Service mindset

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 CompaniesCertified as a Great Place to Work®Fortune Best Workplaces in Financial Services & InsuranceClaims Adjuster Liablity

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.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.