Arizona Staffing
Claims Examiner, Auto Bodily Injury
By joining Sedgwick, you'll be part of something truly meaningful. It's 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, there's no limit to what you can achieve. The primary purpose of this role is to 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. Essential functions and responsibilities include: Analyzing and processing complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; managing claims through well-developed action plans to an appropriate and timely resolution. Assessing liability and resolving claims within evaluation. Negotiating settlement of claims within designated authority. Calculating and assigning timely and appropriate reserves to claims; managing reserve adequacy throughout the life of the claim. Calculating and paying benefits due; approving and making timely claim payments and adjustments; and settling claims within designated authority level. Preparing necessary state filings within statutory limits. Managing the litigation process; ensuring timely and cost effective claims resolution. Coordinating vendor referrals for additional investigation and/or litigation management. Using appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Managing claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Reporting claims to the excess carrier; responding to requests of directions in a professional and timely manner. Communicating claim activity and processing with the claimant and the client; maintaining professional client relationships. Ensuring claim files are properly documented and claims coding is correct. Referring cases as appropriate to supervisor and management. Additional functions and responsibilities include: Performing other duties as assigned. Supporting the organization's quality program(s). Traveling as required. Qualifications: Education & Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience: Five (5) years of claims management experience or equivalent combination of education and experience required. 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. 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. 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. 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.
By joining Sedgwick, you'll be part of something truly meaningful. It's 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, there's no limit to what you can achieve. The primary purpose of this role is to 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. Essential functions and responsibilities include: Analyzing and processing complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; managing claims through well-developed action plans to an appropriate and timely resolution. Assessing liability and resolving claims within evaluation. Negotiating settlement of claims within designated authority. Calculating and assigning timely and appropriate reserves to claims; managing reserve adequacy throughout the life of the claim. Calculating and paying benefits due; approving and making timely claim payments and adjustments; and settling claims within designated authority level. Preparing necessary state filings within statutory limits. Managing the litigation process; ensuring timely and cost effective claims resolution. Coordinating vendor referrals for additional investigation and/or litigation management. Using appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Managing claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Reporting claims to the excess carrier; responding to requests of directions in a professional and timely manner. Communicating claim activity and processing with the claimant and the client; maintaining professional client relationships. Ensuring claim files are properly documented and claims coding is correct. Referring cases as appropriate to supervisor and management. Additional functions and responsibilities include: Performing other duties as assigned. Supporting the organization's quality program(s). Traveling as required. Qualifications: Education & Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience: Five (5) years of claims management experience or equivalent combination of education and experience required. 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. 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. 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. 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.