Claims Examiner | Multi-Line | Public Entity

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Claims Examiner | Multi-Line | Public Entity | Remote

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?

Enjoy flexibility and autonomy in your daily work your location and your career path.

• Be a part of a rapidly growing industry-leading global company known for its excellence and customer service.

• Access diverse and comprehensive benefits to take care of your mental physical financial and professional needs.

ARE YOU AN IDEAL CANDIDATE? No day is ever the same assisting our public entity clients with their claims! If you are an agile multi-line examiner with 5+ years of experience handling both 3rd party liability and 1st party property claims we want to talk to you! This examiner will primarily handle liability for the following lines of coverage: General Liability Auto Liability Employment Practices Liability Law Enforcement Liability and Public Officials Liability. Texas adjuster license is a plus.

PRIMARY PURPOSE : To analyze complex or technically difficult multi-product line 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

• Analyzes and processes complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; assesses damages; manages claims through well-developed action plans to an appropriate and timely resolution.

• Assesses 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.

• Secures and disposes of salvage.

• 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 insured client and agent or broker as appropriate; maintains professional client relationships.

• Ensures claim files are properly documented and claims coding is correct.

• Refers cases as appropriate to supervisor and management.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Travels as required.

QUALIFICATION

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

As required by law Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set level of experience and cost of specific location. For the jurisdiction noted in this job posting only the range of starting pay for this role is $80000 to $95000 USD annual salary . Bonus eligible role. A comprehensive benefits package is offered including but not limited to medical dental vision 401k and matching PTO disability and life insurance employee assistance flexible spending or health savings account and other additional voluntary benefits.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions duties or local variances. Management retains the discretion to add or to change the duties of the position at any time.

#LI-REMOTE #claimsexaminer #remote

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.