Claims Examiner - Construction

Sedgwick; United States; On-site; USD 75,000 - 100,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

401k with matching

Paid time off

Disability and life insurance

Employee assistance programs

Job summary

A prominent claims management company in the United States is seeking a Claims Examiner to analyze complex liability claims, negotiate settlements, and ensure compliance with client service expectations. Candidates should have a Bachelor’s degree and five years of claims management experience. The role offers a salary range of $75,000 - $100,000 per year, along with a comprehensive benefits package including medical, dental, and retirement options.

Qualifications

• Five years of claims management experience or equivalent education and experience.
• Professional certification as applicable to line of business preferred.

Responsibilities

• Analyze complex general liability claims and determine damages.
• Negotiate claims settlements within authority.
• Manage and document claims processing.

Skills

Insurance principles and laws

Excellent communication skills

PC literate, including Microsoft Office

Analytical skills

Strong organizational skills

Negotiation skills

Teamwork

Education

Bachelor's degree from an accredited college

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 Examiner - Construction

PRIMARY PURPOSE

To analyze complex or technically difficult general liability claims to determine damages; to work with high exposure claims involving litigation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify risk transfer opportunities and negotiate settlements.

ESSENTIAL FUNCTIONS And RESPONSIBILITIES

• Analyzes and processes complex or technically difficult general liability claims involving New York Labor Law claims or construction defect cases by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Assesses liability and resolves claims within evaluation.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays damages; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
• Manages the litigation process; ensures timely and cost effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.

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. Professional certification as applicable to line of business preferred.

Experience

Five (5) 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 $75,000 - $100,000/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.