Job Details

divh2Claims Examiner At Sedgwick/h2pBy joining Sedgwick, youll be part of something truly meaningful. Its 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, theres no limit to what you can achieve./ppAs a Claims Examiner at Sedgwick, youll 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./ph3Are You An Ideal Candidate?/h3pDo 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 youre looking to join one of the premier teams in the industry, were looking for someone with your level of expertise./ph3Primary Purpose/h3pTo 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./ph3Essential Functions and Responsibilities/h3ulliAnalyzes 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./liliAssesses liability and resolves claims within evaluation./liliNegotiates settlement of claims within designated authority./liliCalculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim./liliCalculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level./liliPrepares necessary state fillings within statutory limits./liliManages the litigation process; ensures timely and cost effective claims resolution./liliCoordinates vendor referrals for additional investigation and/or litigation management./liliUses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients./liliManages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets./liliReports claims to the excess carrier; responds to requests of directions in a professional and timely manner./liliCommunicates claim activity and processing with the claimant and the client; maintains professional client relationships./liliEnsures claim files are properly documented and claims coding is correct./liliRefers cases as appropriate to supervisor and management./li/ulh3Additional Functions and Responsibilities/h3ulliPerforms other duties as assigned./liliSupports the organizations quality program(s)./liliTravels as required./li/ulh3Qualifications/h3h4Education Licensing/h4pBachelors degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred./ph4Experience/h4pFive (5) years of claims management experience or equivalent combination of education and experience required./ph4Skills Knowledge/h4pSubject 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./ppExcellent oral and written communication, including presentation skills/ppPC literate, including Microsoft Office products/ppAnalytical and interpretive skills/ppStrong organizational skills/ppGood interpersonal skills/ppExcellent negotiation skills/ppAbility to work in a team environment/ppAbility to meet or exceed Service Expectations/ph4Work Environment/h4pWhen applicable and appropriate, consideration will be given to reasonable accommodations./ppMental: 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/ppPhysical: Computer keyboarding, travel as required/ppAuditory/Visual: Hearing, vision and talking _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $85,000.00 - $100,000.00 annual salary. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Always accepting applications./p/div