Remote General Liability Claims Adjuster I

Sedgwick; Dover (DE); Remote; USD 63,000 - 90,000; Full time

Job summary

Sedgwick in the United States is hiring a Claims Adjuster I Captive I PD Experience I Remote to analyze mid-level general liability claims and determine benefits due. You’ll adjudicate claims within policy and standards, and manage subrogation and settlements with clients.

Required are a bachelor’s degree (preferred) and at least four years of claims management experience, plus strong negotiation, communication, and Microsoft Office skills. Remote work with occasional travel.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Four (4) 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.

Job description

Sedgwick in the United States is hiring a Claims Adjuster I Captive I PD Experience I Remote to analyze mid-level general liability claims and determine benefits due. You’ll adjudicate claims within policy and standards, and manage subrogation and settlements with clients.

Required are a bachelor’s degree (preferred) and at least four years of claims management experience, plus strong negotiation, communication, and Microsoft Office skills. Remote work with occasional travel.