Claims Examiner - Liability | Jurisdiction: All 50 States | Licensing: IA, TX, or FL Required (Hybrid)

Sedgwick • West Des Moines, IA • 1h ago

West Des Moines, IA

R78180

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 - Liability | Jurisdiction: All 50 States | Licensing: IA, TX, or FL Required (Hybrid)

PRIMARY PURPOSE : 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 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.

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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.

Supports the organization's quality program(s).

Travels as required.

QUALIFICATION

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 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.

Excellent oral and written communication, including presentation skills

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

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

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. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is?($60,000-84k). 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.

claimsexaminer?#claims #hybrid?

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

Similar Jobs

Claims Adjuster - Liability | GL, BI, PD | Jurisdiction - All states | Licensing: Home State Required - Hybrid

Sedgwick • West Des Moines, IA • 1h ago

Finance, Accounting & Banking

Irving, TX West Des Moines, IA R78249 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 y...

1h ago

Go to Apply

Fund Finance Manager

Deloitte • Des Moines, IA • 21h ago

Finance, Accounting & Banking

Are you an experienced, passionate pioneer in technology who wants to work in a collaborative environment? As an experienced Fund Finance Manager, you will have the ability to share new ideas and collaborate on projects...

21h ago

Go to Apply

Manager, Finance & Accounting

NTT America, Inc. • Des Moines, IA • 21h ago

Finance, Accounting & Banking

Thank you for your interest in NTT DATA Business Solutions! We are thrilled to offer an exceptional compensation package that includes competitive salaries, comprehensive health and dental benefits, Flexible Paid Time Of...

21h ago

Go to Apply

Strategy and Transformation Manager Mortgage Banking

City National Bank • Des Moines, IA • 23h ago

Finance, Accounting & Banking

STRATEGY AND TRANSFORMATION MANAGER MORTGAGE BANKING WHAT IS THE OPPORTUNITY? The Strategy and Transformation Manager Mortgage Banking will be a trusted advisor and strategic partner to the EVP of Mortgage, responsible f...

23h ago

Go to Apply

Finance Transformation Sr Manager - Resources Industry

Accenture • Des Moines, IA • 1d ago

Finance, Accounting & Banking

We are: We partner with Finance executives to drive value across the enterprise. As Finance leaders move into business partner roles, they need processes, technology and people to help drive efficiencies, manage costs, i...

1d ago

Go to Apply

Accounting Assistant

Ken Garff Automotive Group • Ankeny, IA • 1d ago

Finance, Accounting & Banking

Dewey Chrysler Dodge Jeep Ram - Ankeny, IA Full time R0043544 Dewey Dodge, a Ken Garff Automotive company, is currently looking for a talented Accounting Assistant to support our accounting team in processing daily opera...

1d ago

Go to Apply

D365 Sr Finance Consultant

Cognizant • Des Moines, IA • 1d ago

Finance, Accounting & Banking

Applicants must be authorized to work in the US without sponsorship. Please note, this role is not able to offer visa transfer or sponsorship now or in the future. We are seeking D365 Sr Finance Consultant to support the...

1d ago

Go to Apply

Claims Adjuster - General Liability | Jurisdiction: All states | Licensing: Home state Required

Sedgwick • Des Moines, IA • 2d ago

Finance, Accounting & Banking

Eden Prairie, MN Telecommuter TX US Telecommuter Telecommuter MN R78077 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...

2d ago

Go to Apply

IT Finance Systems Analyst - Internship

Athene • West Des Moines, IA • 2d ago

Finance, Accounting & Banking

West Des Moines, Iowa Full time R255107 We are driven to do more. More for our customers and the financial professionals who offer our products. If you are driven to do more and love the challenge of pursuing more, Athen...

2d ago

Go to Apply

Finance Intern

Akamai Technologies, Inc. • Des Moines, IA • 2d ago

Finance, Accounting & Banking

Do you want to enhance your corporate finance experience with a cutting-edge technology company? Are you looking to join a motivated, curious team of rotation program mentors and industry leaders? Work with our corporate...

2d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)