Claims Examiner, General Liability
Sedgwick
full-time
Posted on:
Location Type: Office
Location: La Crosse • Wisconsin • United States
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About the role
- Analyze complex or technically difficult general liability claims to determine benefits due
- Work with high exposure claims involving litigation and rehabilitation
- Ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements
- Identify subrogation of claims and negotiate settlements
- Investigate and gather information to determine the exposure on the claim
- 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
- Approve and make timely claim payments and adjustments
- Prepare necessary state filings within statutory limits
- Manage the litigation process; ensures timely and cost effective claims resolution
- Communicate claim activity and processing with the claimant and the client; maintains professional client relationships
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
- caring culture
- work-life balance
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims managementnegotiationliability assessmentsubrogationreserve managementstatutory filingscost containmentmedical managementSocial Security applicationMedicare application
Soft Skills
oral communicationwritten communicationpresentation skillsanalytical skillsorganizational skillsinterpersonal skillsnegotiation skillsteamworkservice expectations
Certifications
Bachelor's degreeprofessional certification