Insurance Verification Representative
Huron
Claims Adjuster, Liability, Hybrid
Sedgwick
full-time
Posted on:
Location: Illinois • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- - Manages mid-level general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level. - Assesses liability and resolves claims within evaluation. - Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract. - Manages subrogation of claims and negotiates settlements. - Communicates claim action with claimant and client. - Ensures 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. - Maintains professional client relationships. - Travels as required.
Requirements
- - Bachelor's degree from an accredited college or university 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 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
