Remote Claims Adjuster I - General Liability PD Experience

Sedgwick; Augusta (ME); Remote; USD 63,000 - 90,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401k and matching

PTO

Job summary

Sedgwick is seeking a US Telecommuter Claims Adjuster I to analyze mid-level general liability claims and determine benefits due, while adjudicating claims according to company standards and best practices. The role supports remote work with a focus on timely, accurate claim handling and professional client relationships.

You will handle subrogation, settlements, and claim communications, maintaining detailed documentation and collaborating with team members to meet service expectations.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Four years of claims management experience or equivalent combination of education and experience required.
• 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

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.

Skills

Analytical skills

Oral & written communication

Team player

Problem solving

Interpersonal skills

Education

Bachelor's degree

Tools

Microsoft Office

Job description

Sedgwick is seeking a US Telecommuter Claims Adjuster I to analyze mid-level general liability claims and determine benefits due, while adjudicating claims according to company standards and best practices. The role supports remote work with a focus on timely, accurate claim handling and professional client relationships.

You will handle subrogation, settlements, and claim communications, maintaining detailed documentation and collaborating with team members to meet service expectations.