Claims Examiner - Liability BI/Auto exp required (REMOTE)

Sedgwick; United States; Remote; USD 60,000 - 100,000; Full time

Job summary

Join a forward-thinking company dedicated to making a meaningful impact in the lives of others. As a Claims Examiner, you'll analyze complex liability claims, ensuring timely resolutions and maintaining professional relationships with clients. This role offers the opportunity to work in a supportive, inclusive environment that values your contributions. With a focus on work-life balance, you'll have the chance to grow your career while making a difference in the insurance industry. If you're ready to take on a challenging yet rewarding role, this is the perfect opportunity for you.

Qualifications

• 5+ years of claims management experience required.
• Bachelor's degree preferred for this role.

Responsibilities

• Analyze and process complex general liability claims.
• Negotiate settlements and manage claims through resolution.

Skills

Insurance Principles

Claims Management

Negotiation Skills

Analytical Skills

Communication Skills

Organizational Skills

Interpersonal Skills

PC Literacy

Education

Bachelor's Degree

Tools

Microsoft Office

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 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 - Liability BI/Auto exp required (REMOTE)

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

1. 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.
2. Assesses liability and resolves claims within evaluation.
3. Negotiates settlement of claims within designated authority.
4. Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
5. Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
6. Prepares necessary state filings within statutory limits.
7. Manages the litigation process; ensures timely and cost-effective claims resolution.
8. Coordinates vendor referrals for additional investigation and/or litigation management.
9. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
10. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
11. Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
12. Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
13. Ensures claim files are properly documented and claims coding is correct.
14. Refers cases as appropriate to supervisor and management.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

1. Performs other duties as assigned.
2. Supports the organization's quality program(s).
3. 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.

Experience

Five (5) years of claims management experience or an equivalent combination of education and experience required.

Skills & Knowledge

• Subject matter expert of appropriate insurance principles and laws for the 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

Credit security clearance, confirmed via a background credit check, is required for this position.

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.