Sedgwick · 3 days ago

Claim Examiner - Litigation Exp Required

Florida, United States

Full-time

Remote

Senior Level, Lead/Staff

10+ years exp

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Responsibilities

Reviews/acts on reports/forms; responds to inquiries; seeks legal opinion and early resolution; and communicates resolution to appropriate parties.

Handles high end cases with serious injuries and/or complex coverage scenarios.

Responds to decisions, agreement, and/or court order; creates action plan; determines need for examination; gains client authorization.

Identifies cases for settlements/redemptions.

Gathers/documents additional information and coordinates with client designees.

Requests legal/private investigation; assigns to and coordinates with local counsel; monitors local counsel performance.

Responds to plaintiff's counsel, union, employee, or client requests.

Identifies issues and formulates defense strategy.

Establishes/adjusts accrued liability and approves administrative expenses.

Identifies subrogation opportunities and manages process.

Attends and participates in mediations, trials, arbitrations or hearings as needed.

Works with partners to affect early return-to-work.

Performs other duties as assigned.

Supports the organization's quality program(s).

Qualification

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Juris Doctorate ()Litigation experienceClaims management experienceInsurance principlesLegal pleadings knowledgeMedical management practicesSocial Security proceduresMicrosoft OfficeTeamwork ability

Required

Ten (10) years of experience handling litigation including 5 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.

Technically skilled and familiar with legal pleadings, discovery et al.

Excellent oral and written communication, including presentation skills.

PC literate, including Microsoft Office products.

Analytical and interpretive skills.

Strong organizational skills.

Excellent interpersonal skills.

Excellent negotiation skills.

Ability to work in a team environment.

Ability to meet or exceed Performance Competencies.