Claims Examiner - Liability REMOTE
Claims Examiner - Liability REMOTE
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Salary Not Disclosed
1 Vacancy
Job Description
Taking care of people is at the heart of everything we do and we start by taking care of you our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. Its an opportunity to do something meaningful each and every day. Its having support for your mental physical financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference who enjoys a challenge and above all if youre someone who cares theres a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to Work
Most Loved Workplace
Forbes BestinState Employer
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 welldeveloped 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 clams 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 organizations quality program(s).
- Travels as required.
QUALIFICATION
Education & Licensing
Bachelorsdegree 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 lineofbusiness 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 lineofbusiness.
- 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 workrelated 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.
Sedgwickis an Equal Opportunity Employer and a DrugFree Workplace.
If youre excited about this role but your experience doesnt 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.
Employment Type
Full-Time
