PRIMARY PURPOSE

: To analyze reports claims, determine benefits due and make timely payments and adjustments; to make timely payments and adjustments for specified program claims including high value and complex claims; to coordinate investigative efforts; to thoroughly review contested claims; to negotiate settlement of claims up to the designated authority level; and to provide superior customer services.

ESSENTIAL

FUNCTIONS and

RESPONSIBILITIES

Manages first party property, casualty and/or medical reimbursement claims based on multiple/additional coverage and/or programs as defined by client-specific program. Makes coverage determinations based on investigation/evaluation and communicates claim actions with claimant and client. Adjudicates proper settlement up to designated authority level. Works directly with underwriter/client on high value and complex cases. Handles high volume of claims, phone calls and correspondence ensuring claim files are properly documented; meets quality and production goals; and meets customer guidelines and deadlines..

ADDITIONAL

FUNCTIONS and

RESPONSIBILITIES

Performs other duties as assigned. Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing Bachelor's degree from and accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience Three (3) years of claims management experience or equivalent combination of experience and education required. Skills & Knowledge In-depth knowledge of first party property and casualty claim adjudication as applicable to line of business Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Excellent analytical and interpretive skills Excellent organizational skills Excellent interpersonal skills Ability to work in a team environment Ability to meet or exceed Performance Competencies

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 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. 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. 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