Description
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.
As a Claims Examiner, Auto | Bodily Injury, you will analyze complex or technically difficult auto and general liability claims to determine benefits due; work with high exposure claims involving litigation and rehabilitation; ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and identify subrogation of claims and negotiate settlements.
Responsibilities
- Analyze and process complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manage claims through well-developed action plans to an appropriate and timely resolution.
- Assess liability and resolve claims within evaluation.
- Negotiate settlement of claims within designated authority.
- Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
- Calculate and pay benefits due; approve and make timely claim payments and adjustments; and settle claims within designated authority level.
- Prepare necessary state filings within statutory limits.
- Manage the litigation process; ensure timely and cost-effective claims resolution.
- Coordinate vendor referrals for additional investigation and/or litigation management.
- Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
- Manage claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
- Report claims to the excess carrier; respond to requests of directions in a professional and timely manner.
- Communicate claim activity and processing with the claimant and the client; maintain professional client relationships.
- Ensure claim files are properly documented and claims coding is correct.
- Refer cases as appropriate to supervisor and management.
- Perform other duties as assigned.
- Support the organization's quality program(s).
Qualifications
- Education & Licensing: Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws.
- Bachelor's degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
- Skills: strong oral and written communication, including presentation skills, PC literate including Microsoft Office products, and ability to work in a team environment.
- Secure and maintain the State adjusting licenses as required for the position.
Work Environment Requirements
- Physical: Computer keyboarding
- Auditory/visual: Hearing, vision and talking
- Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.