Claims Examiner – Texas Non-Subscriber
Sedgwick
full-time
Posted on:
Location Type: Hybrid
Location: Plano • Texas • United States
Visit company websiteExplore more
About the role
- Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim;
- manages claims through well-developed action plans to an appropriate and timely resolution.
- Assesses liability 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 claims 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.
- 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 and the client; maintains professional client relationships.
- Ensures claim files are properly documented and claims coding is correct.
- Refers cases as appropriate to supervisor and management.
- Performs other duties as assigned. Supports the organization's quality program(s).
Requirements
- Bachelor's degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
- Five (5) years of claims management experience or equivalent combination of education and experience required.
Benefits
- 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims managementliability assessmentnegotiationreserve calculationclaims processingcost containmentsubrogationlitigation managementvendor coordinationclaims coding
Soft Skills
communicationprofessional relationship managementanalytical thinkingproblem-solvingtime management
Certifications
professional certification