Claims Examiner, Auto, Bodily Injury, GL
Sedgwick
full-time
Posted on:
Location Type: Remote
Location: Wisconsin • United States
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Salary
💰 $70,000 - $75,000 per year
About the role
- To analyze complex or technically difficult general liability claims to determine benefits due
- To work with high exposure claims involving litigation and rehabilitation
- To ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements
- To identify subrogation of claims and negotiate settlements
- 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
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
Benefits
- medical, dental, vision
- 401k and matching
- PTO
- disability and life insurance
- employee assistance
- flexible spending or health savings account
- other additional voluntary benefits
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims managementnegotiationsubrogationliability assessmentcost containmentclaims adjudicationreserve calculationlitigation managementmedical management practicesinsurance principles
Soft Skills
communicationorganizational skillsinterpersonal skillsanalytical skillspresentation skillsteamworknegotiation skillsproblem-solvingtime managementclient relationship management
Certifications
Bachelor's degreeprofessional certification in insurance