Claims Adjuster – Accident Benefits
Sedgwick
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇨🇦 Canada
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Analyze mid- and higher-level general liability claims to determine benefits due
- Ensure ongoing adjudication of claims within company standards and industry best practices
- Identify subrogation of claims and negotiate settlements
- Manage mid-level general liability claims by gathering information to determine liability exposure; assign reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level
- Assess liability and resolve claims within evaluation
- Approve and process assigned claims, determine benefits due, and manage action plan pursuant to the claim or client contract
- Manage subrogation of claims and negotiate settlements
- Communicate claim action with claimant and client
- Ensure claim files are properly documented and claims coding is correct
- May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review
- Maintain professional client relationships
Requirements
- Bachelor's degree or college diploma preferred
- Four (4) 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
- Excellent oral and written communication
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims managementliability assessmentnegotiationclaims codingmedical claims processingsubrogationcost containment principlesinsurance principlesanalytical skillsinterpretive skills
Soft skills
oral communicationwritten communicationorganizational skillsinterpersonal skillsnegotiation skillsteamworkservice expectations
Certifications
Bachelor's degreecollege diploma