[Remote] Claims Examiner, General Liability | Remote
Note: The job is a remote job and is open to candidates in USA. Sedgwick is a leading claims management services company dedicated to helping people facing unexpected challenges. The Claims Examiner, General Liability role involves analyzing complex general liability claims, managing litigation processes, and ensuring timely resolution while maintaining professional client relationships.
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
Skills
• Bachelor's degree from an accredited college or university preferred
• Five (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
• 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
• Professional certification as applicable to line of business preferred
Company Overview
• Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected. It was founded in 1969, and is headquartered in Memphis, Tennessee, USA, with a workforce of 10001+ employees. Its website is http://www.sedgwick.com.
Apply Now
Apply Now
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
Skills
• Bachelor's degree from an accredited college or university preferred
• Five (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
• 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
• Professional certification as applicable to line of business preferred
Company Overview
• Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected. It was founded in 1969, and is headquartered in Memphis, Tennessee, USA, with a workforce of 10001+ employees. Its website is http://www.sedgwick.com.
Apply Now
Apply Now