Claims Examiner – Liability, GL/Complex Bodily Injury Exp
Sedgwick
full-time
Posted on:
Location Type: Remote
Location: North Carolina • United States
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About the role
- To analyze mid- and higher-level general liability claims to determine benefits due.
- To ensure ongoing adjudication of claims within company standards and industry best practices.
- To identify subrogation of claims and negotiate settlements.
- 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.
- Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
- 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.
Requirements
- Bachelor's degree from an accredited college or university preferred.
- 4 years of Liability claims management experience or equivalent combination of education and experience required.
Benefits
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims analysisliability claims managementnegotiationclaims adjudicationclaims processingclaims codingsubrogationreserve valuationmedical claims processingutilization review
Soft Skills
communicationorganizational skills