Sedgwick
Claims Examiner | General Liability BI | Captive | Remote
Sedgwick, New York, New York, United States
Overview
Claims Examiner | General Liability BI | Captive | Remote As a Claims Examiner at Sedgwick, youll have the opportunity to take on new challenges and help solve complex problems. By joining Sedgwick, you'll be part of a meaningful culture with opportunities to grow your career, enjoy work-life balance, and contribute to a caring organization recognized for excellence in the industry. Responsibilities
Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine exposure; manages claims through well-developed action plans to resolution. Assesses liability and resolves claims within evaluation. Negotiates settlement of claims within designated authority. Calculates and assigns reserves; manages reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves and makes timely claim payments and adjustments; settles claims within designated authority level. Prepares necessary state filings 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 cost containment techniques including strategic vendor partnerships to reduce overall claim costs for clients. Manages claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets. Reports claims to excess carrier; responds to directions in a professional and timely manner. Communicates claim activity with the claimant and client; maintains professional client relationships. Ensures claim files are properly documented and claims coding is correct; refers cases to supervisor as needed. Additional Functions
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. 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; good judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities and deadlines. Physical: Computer keyboarding, travel as required. Auditory/Visual: Hearing, vision and talking. Compensation: The jurisdiction noted in this job posting may have pay transparency requirements. The stated range is provided where applicable. Salary range: $85,000.00 - $100,000.00 annual salary. A comprehensive benefits package is offered including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other benefits. Additional Information
Always accepting applications. The statements describe the general nature and level of work performed by a colleague assigned to this description and are not intended to be a comprehensive list of duties. Management may change duties at any time. #LI-REMOTE #claimsexaminer Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. Sedgwick is the worlds leading risk and claims administration partner, with 33,000 colleagues and 10,000 clients across 80 countries. For more, see sedgwick.com. #J-18808-Ljbffr
Claims Examiner | General Liability BI | Captive | Remote As a Claims Examiner at Sedgwick, youll have the opportunity to take on new challenges and help solve complex problems. By joining Sedgwick, you'll be part of a meaningful culture with opportunities to grow your career, enjoy work-life balance, and contribute to a caring organization recognized for excellence in the industry. Responsibilities
Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine exposure; manages claims through well-developed action plans to resolution. Assesses liability and resolves claims within evaluation. Negotiates settlement of claims within designated authority. Calculates and assigns reserves; manages reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves and makes timely claim payments and adjustments; settles claims within designated authority level. Prepares necessary state filings 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 cost containment techniques including strategic vendor partnerships to reduce overall claim costs for clients. Manages claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets. Reports claims to excess carrier; responds to directions in a professional and timely manner. Communicates claim activity with the claimant and client; maintains professional client relationships. Ensures claim files are properly documented and claims coding is correct; refers cases to supervisor as needed. Additional Functions
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. 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; good judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities and deadlines. Physical: Computer keyboarding, travel as required. Auditory/Visual: Hearing, vision and talking. Compensation: The jurisdiction noted in this job posting may have pay transparency requirements. The stated range is provided where applicable. Salary range: $85,000.00 - $100,000.00 annual salary. A comprehensive benefits package is offered including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other benefits. Additional Information
Always accepting applications. The statements describe the general nature and level of work performed by a colleague assigned to this description and are not intended to be a comprehensive list of duties. Management may change duties at any time. #LI-REMOTE #claimsexaminer Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. Sedgwick is the worlds leading risk and claims administration partner, with 33,000 colleagues and 10,000 clients across 80 countries. For more, see sedgwick.com. #J-18808-Ljbffr