Overview
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 | Public Entity Liability | Ohio. Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?
Responsibilities- Enjoy flexibility and autonomy in your daily work, your location, and your career path. This role is open to a work-at-home, remote, telecommuter setting in Ohio, with occasional travel required.
- Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
- Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
- Analyze complex or technically difficult general liability claims to determine exposure and determine benefits due.
- Work with high-exposure claims involving litigation and rehabilitation, ensuring ongoing adjudication within service expectations and client requirements.
- Identify subrogation opportunities and negotiate settlements when appropriate.
ARE YOU AN IDEAL CANDIDATE? No day is ever the same assisting our public entity clients with their claims. If you are an agile examiner with 5+ years of experience handling both 3rd party liability and 1st party property claims, we want to talk to you. This examiner will primarily handle liability for Ohio/Nebraska and the following lines of coverage:
General Liability, Auto Liability, Employment Practices Liability, Law Enforcement Liability and Public Officials Liability.
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 exposure; manages claims through action plans to reach timely resolutions.
- 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; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
- Prepares necessary state filings 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 cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
- Manages claim recoveries, including subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
- Reports claims to the excess carrier; responds to 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.
- Performs other duties as assigned.
- Supports the organization's quality programs.
- Travels as required.
Education & Licensing
Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
Experience
Five (5) years of claims…
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