Senior Research Manager
Human8
Claims Specialist, General Liability, Property
Sedgwick
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $80,000 per year
Job Level
Mid-LevelSenior
About the role
- 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 fillings 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)
- Travel as required
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
- 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
