Claims Examiner, Auto | Occupational Accident

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Claims Examiner, Auto | Occupational Accident

• PRIMARY PURPOSE OF THE ROLE

• To analyze complex or technically difficult occupational accident 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 RESPONSIBLITIES MAY INCLUDE

• + Analyzes and processes complex or technically difficult occupational accident 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.

+ 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.

• QUALIFICATIONS

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Education & Licensing:

Five (5) years of claims management experience or equivalent combination of education and experience required. + Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Skills:

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, excellent oral and written communication, including presentation skills, PC literate, including Microsoft Office products

• WORK ENVIRONMENT

• When 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 deadlines

• Physical:

• Computer keyboarding, travel as required

• Auditory/Visual:

• Hearing, vision and talking
• Work environment requirements include -

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Physical:

Computer keyboarding

Auditory/visual:

Hearing, vision and talking

Mental:

Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines. 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. at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

• If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
• Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected.

The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see

• sedgwick.com

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