REMOTE POSITION / CLAIMS PROCESSOR

Claims Examiner At Sedgwick 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. As a Claims Examiner at Sedgwick, you'll have the opportunity to take on new challenges and help solve complex problems. This is a remote, work-at-home, telecommuter position. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Do you have experience as a Bodily Injury General Liability Claims Examiner working within commercial (captive) insurance program(s)? Are you skilled in coverage determination, handling litigated claims, and interpreting endorsements, nature of loss, and excluded coverages? 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. 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. approves and makes timely claim payments and adjustments; and settles claims within designated authority level. 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; Communicates claim activity and processing with the claimant and the client; Ensures claim files are properly documented and claims coding is correct. Supports the organization's quality program(s). Travels as required. Education & Licensing Bachelor's degree from an accredited college or university preferred. Experience Five (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. PC literate, including Microsoft Office products. excellent judgment, troubleshooting, problem solving, analysis, and discretion; Physical Computer keyboarding, travel as required. Auditory/Visual Hearing, vision and talking _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. 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. Always accepting applications. Apply tot his job