Claims Examiner, BI (REMOTE)

Sedgwick; Town of Texas (WI); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading insurance provider is seeking an experienced Claims Manager to analyze and process complex auto and commercial transportation claims. The ideal candidate will have at least five years of claims management experience and a thorough understanding of insurance policies. This role offers the opportunity to work in a collaborative environment with a strong commitment to inclusive workplace practices.

Qualifications

• Five years of claims management experience required.
• Professional certification preferred.

Responsibilities

• Process complex auto commercial and personal line claims.
• Responsible for litigation process on litigated claims.
• Communicate claim processing with insured, client, and agent.

Skills

In-depth knowledge of personal and commercial line auto policies

Knowledge of medical terminology

Strong oral and written communication skills

Organization skills

Negotiation skills

Education

Bachelor's degree from an accredited college or university

Tools

Microsoft Office products

Job description

Overview

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

Primary Purpose

To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.

Essential Functions and Responsibilities

• Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.
• Responsible for litigation process on litigated claims.
• Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.
• Reports large claims to excess carrier(s).
• Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.
• Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.
• Communicates claim action/processing with insured, client, and agent or broker when appropriate.

Additional Functions and Responsibilities

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

Qualifications

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position.

Experience

Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage’s, principles, and laws.

Skills & Knowledge

• In-depth knowledge of personal and commercial line auto policies, coverage’s, principles, and laws
• Knowledge of medical terminology for claim evaluation and Medicare compliance
• Knowledge of appropriate application for deductibles, sub-limits, SIR’s, carrier and large deductible programs.
• Strong oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Strong organizational skills
• Strong interpersonal skills
• Good 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.