Sedgwick · 13 hours ago
Claim Examiner - Liability (REMOTE- Needs Gen Liab Experience)
Telecommuter AL
Full-time
Remote
Mid, Senior Level
5+ years exp
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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 well-developed 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.
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.
Qualification
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Required
Five (5) years of claims management experience or equivalent combination of education and experience
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
Preferred
Bachelor's degree from an accredited college or university
Professional certification as applicable to line of business
Company
Sedgwick
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions.
10001+ employees
H1B Sponsorship
Sedgwick has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (3)
2022 (9)
2021 (14)
2020 (9)
Funding
Current Stage
Late StageTotal Funding
$1.5BKey Investors
Altas PartnersCaisse de Depot et Placement du Quebec
2024-09-12Private Equity· $1B
2018-12-01Private Equity
2018-09-12Acquired
Leadership Team
Michael Arbour
Chief Executive Officer
Kimberly George
Senior Vice President
Recent News
2024-11-15
2024-03-04
2024-01-22
Company data provided by crunchbase
