Claims Examiner- General Liability (Remote)

Job Overview

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. It’s an opportunity to do something meaningful, each and every day. It’s 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 you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

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Claims Examiner- General Liability (Remote)

PRIMARY PURPOSE:  To analyze complex or technically difficult general liability claims to determine benefits and/or to analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Processes complex general liability claims by investigating and gathering information to determine the exposure on the claim and/or auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.
• Responsible for litigation process on litigated claims.
• Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.
• Reports large claims to excess carrier(s).
• Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.
• Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.
• Communicates claim action/processing with insured, client, and agent or broker when appropriate.
• 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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• 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. Secure and maintain the State adjusting licenses as required for the position.

Experience
Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of general liability and/or personal and commercial line auto policies, coverage’s, principles, and laws.

Skills & Knowledge

• 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.
• In-depth knowledge of personal and commercial line auto policies, coverage’s, principles, and laws
• Knowledge of medical terminology for claim evaluation and Medicare compliance
• Knowledge of appropriate application for deductibles, sub-limits, SIR’s, carrier and large deductible programs.
• Strong oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Strong organizational skills
• Strong interpersonal skills
• Good 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.

#claimsexaminer

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in CO, NY, WA, or CA. 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 state noted in this job posting only, the range of starting pay for this role is $67,466 - 94,453. 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. 

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.