Claims Examiner | General Liability BI | Captive | Remote

Sedgwick; Jefferson City (MO); Remote; USD 85,000 - 100,000; Full time

Job summary

A leading risk management firm is seeking a Claims Examiner specializing in General Liability to analyze and manage complex claims. This remote position requires strong negotiation and analytical skills, along with five years of experience in claims management. The role offers flexibility, autonomy, and a supportive company culture with a competitive salary range of $85,000 - $100,000 annually.

Benefits

Medical, dental, and vision insurance

401k with matching

Paid time off (PTO)

Qualifications

• Five years of claims management experience or equivalent
• Subject matter expert in insurance principles and laws
• Ability to work in a team environment

Responsibilities

• Analyze and process complex general liability claims
• Negotiate settlement of claims
• Manage claim recoveries including subrogation

Skills

Analytical skills

Negotiation skills

Excellent communication

Interpersonal skills

Education

Bachelor's degree from an accredited college or university

Tools

Microsoft Office

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

Position: Claims Examiner | General Liability BI | Captive | Remote

As a Claims Examiner at Sedgwick, you’ll have the opportunity to take on new challenges and help solve complex problems.

• Enjoy flexibility and autonomy in your daily work and your career path. This is a remote, work-at-home, telecommuter position.
• Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.

ARE YOU AN IDEAL CANDIDATE? Do you have experience as a Bodily Injury General Liability Claims Examiner working within commercial (captive) insurance program(s) ? Are you skilled in coverage determination, handling litigated claims, and interpreting endorsements, nature of loss, and excluded coverages ? If so, and you're looking to join one of the premier teams in the industry, we’re looking for someone with your level of expertise.

PRIMARY PURPOSE: To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Analyzes and processes complex or technically difficult general liability claims 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 benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
• Prepares necessary state fillings within statutory limits.
• 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.
• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• 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

Note: For jurisdictions requiring pay transparency, Sedgwick provides a range of compensation. Actual compensation depends on factors including skill, experience, and location. For the listed jurisdiction, starting pay range is $85,000.00 - $100,000.00 annual salary. A comprehensive benefits package is offered including medical, dental, vision, 401k with matching, PTO, disability and life insurance, EAP, FSA/HSAs, and other voluntary benefits. Always accepting applications.

The statements in this document describe the general nature and level of work performed. They are not intended to be exhaustive. Management may change duties at any time.

#LI-REMOTE #claimsexaminer

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 anyway. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.

Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com