Commercial General Liability Adjuster​/Expert; e en sinistres - Responsabilité civile

Commercial General Liability Adjuster / Expert (en sinistres - Responsabilité civile) at Sedgwick

Join to apply for the Commercial General Liability Adjuster/Expert role at Sedgwick.

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.

To analyze mid- and higher-level general liability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

• Manages mid-level general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
• Assesses liability and resolves claims within evaluation.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

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

Education & Licensing: Bachelor's degree or college diploma preferred.

Experience: Four (4) 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
• Excellent oral and written communication
• 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 Expectations

Sedgwick is an Equal Opportunity Employer.

We are committed to inclusive, barrier-free recruitment and selection processes. If contacted for an employment opportunity, please advise Colleague Resources if you require accommodation.

Analyser les réclamations de niveau intermédiaire et supérieur en matière de responsabilité civile générale afin de déterminer les prestations à payer; assurer le règlement continu des réclamations dans le respect des normes de l’entreprise et des meilleures pratiques du secteur; savoir reconnaître les cas de subrogation et négocier des règlements pour ces réclamations.

• Gérer les réclamations de niveau intermédiaire en matière de responsabilité civile générale en recueillant des informations pour déterminer l’exposition à la responsabilité, attribuer des valeurs de provision aux réclamations, effectuer des paiements au besoin et régler les réclamations selon le niveau d’autorité désigné.
• Évaluer la responsabilité et régler les réclamations dans les paramètres de l’évaluation.
• Approuver et traiter les réclamations attribuées, déterminer les prestations à payer et gérer le plan d’action conformément à la réclamation ou au contrat du client.
• Gérer la subrogation des réclamations et négocier les règlements.
• Communiquer les mesures prises au requérant et au client.
• Veiller à ce que les dossiers de réclamation soient correctement documentés et à ce que les codes de réclamation soient corrects.
• Le cas échéant, traiter les réclamations complexes de remboursement de frais médicaux à vie et/ou de frais médicaux à période déterminée, ce qui comprend les déclarations provincial es et du…