Liability Claims Examiner
Company: Sedgwick
Location: Erie
Posted on: January 20, 2023
Job Description:
The 'Apply with SEEK' option will be utilized for International
applicants, mainly Australia. If this does not apply to you please
use the 'Apply' option.Liability Claims ExaminerIF YOU CARE, THERES
A PLACE FOR YOU HEREFor a career path that is both challenging and
rewarding, join Sedgwicks talented team of 27,000 colleagues around
the globe. Sedgwick is a leading provider of technology-enabled
risk, benefits and integrated business solutions. Taking care of
people is at the heart of everything we do. Millions of people and
organizations count on Sedgwick each year to take care of their
needs when they face a major life event or something unexpected
happens. Whether they have a workplace injury, suffer property or
financial loss or damage from a natural or manmade disaster, are
involved in an auto or other type of accident, or need time away
from work for the birth of a child or another medical situation, we
are here to provide compassionate care and expert guidance. Our
clients depend on our talented colleagues to take care of their
most valuable assetstheir employees, their customers and their
property. At Sedgwick, caring counts. Join our team of creative and
caring people of all backgrounds, and help us make a difference in
the lives of others.With one of the largest teams of liability
experts in the world, Sedgwick supports and resolves property,
general, auto, product and professional liability claims. We help
our clients maintain brand protection in times of crisis.PRIMARY
PURPOSE : 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;
and to identify subrogation of claims and negotiate
settlements.ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- 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 clams 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.ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travels as required.QUALIFICATIONEducation &
LicensingBachelor's degree from an accredited college or university
preferred. Professional certification as applicable to line of
business preferred.ExperienceFive (5) years of claims management
experience or equivalent combination of education and experience
required.Skills & Knowledge
- 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 ExpectationsWORK
ENVIRONMENTWhen applicable and appropriate, consideration will be
given to reasonable accommodations.Mental: Clear and conceptual
thinking ability; excellent judgment, troubleshooting, problem
solving, analysis, and discretion; ability to handle work-related
stress; ability to handle multiple priorities simultaneously; and
ability to meet deadlinesPhysical: Computer keyboarding, travel as
requiredAuditory/Visual: Hearing, vision and talkingNOTE : Credit
security clearance, confirmed via a background credit check, is
required for this position.The statements contained in this
document are intended to describe the general nature and level of
work being performed by a colleague assigned to this description.
They are not intended to constitute a comprehensive list of
functions, duties, or local variances. Management retains the
discretion to add or to change the duties of the position at any
time.As required by law, Sedgwick provides a reasonable range of
compensation for roles that may be hired in (Colorado or New York
City). Actual compensation is influenced by a wide range of factors
including but not limited to skill set, level of experience, and
cost of specific location. For the state noted in this job posting
only, the range of starting pay for this role is 57K-80K. A
comprehensive benefits package is offered including but not limited
to, medical, dental, vision, 401k and matching, PTO, disability and
life insurance, employee assistance, flexible spending or health
savings account, and other additional voluntary benefits.Sedgwick
is an Equal Opportunity Employer and a Drug-Free Workplace.Taking
care of people is at the heart of everything we do. Caring
countsSedgwick is a leading global provider of technology-enabled
risk, benefits and integrated business solutions. Every day, in
every time zone, the most well-known and respected organizations
place their trust in us to help their employees regain health and
productivity, guide their consumers through the claims process,
protect their brand and minimize business interruptions. Our more
than 30,000 colleagues across 80 countries embrace our shared
purpose and values as they demonstrate what it means to work for an
organization committed to doing the right thing one where caring
counts. Watch this video to learn more about us.
(https://www.youtube.com/watch?v=ywxedjBGSfA)
Keywords: Sedgwick, Erie , Liability Claims Examiner, Other , Erie, Pennsylvania
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