Claims Examiner

1 week ago

Orlando, Florida, United States Sedgwick Full time

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work

Most Loved Workplace

Forbes Best-in-State Employer

Claims Examiner - Auto

PRIMARY PURPOSE : To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

  • Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.
  • Responsible for litigation process on litigated claims.
  • Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.
  • Reports large claims to excess carrier(s).
  • Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.
  • Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.
  • Communicates claim action/processing with insured, client, and agent or broker when appropriate.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

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

QUALIFICATIONS

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position.

Experience

Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws.

Skills & Knowledge

  • In-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws
  • Knowledge of medical terminology for claim evaluation and Medicare compliance
  • Knowledge of appropriate application for deductibles, sub-limits, SIR's, carrier and large deductible programs.
  • Strong oral and written communication, including presentation skills
  • PC literate, including Microsoft Office products
  • Strong organizational skills
  • Strong interpersonal skills
  • Good 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

NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.

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.

Pay Transparency:

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 $75, 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.

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.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us. )


  • state veterans' service officer

    1 week ago

    Orlando, Florida, United States State of Florida Full time

    Requisition No: Agency: Veterans Affairs Working Title: STATE VETERANS' SERVICE OFFICER Pay Plan: Career Service Position Number: Salary: $43,184.44 Posting Closing Date: 06/12/2024 Total Compensation Estimator Tool Requisition #830260 STATE VETERANS' SERVICE OFFICER - LAKE NONA FLORIDA DEPARTMENT OF VETERANS' AFFAIRS Bureau of Field Services 13800...

  • law enforcement investigator ii

    3 weeks ago

    Orlando, Florida, United States MyFlorida Full time

    LAW ENFORCEMENT INVESTIGATOR II Date: May 15, 2024 Location: ORLANDO, FL, US, 32801 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ) .Requisition No: Agency: Office of the Attorney GeneralWorking Title: LAW ENFORCEMENT INVESTIGATOR II Pay Plan: Career ServicePosition Number: Salary: $54,600 Annually...

  • law enforcement investigator ii

    1 month ago

    Orlando, Florida, United States MyFlorida Full time

    LAW ENFORCEMENT INVESTIGATOR II Date: May 15, 2024 Location: ORLANDO, FL, US, 32801 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ) .Requisition No: Agency: Office of the Attorney GeneralWorking Title: LAW ENFORCEMENT INVESTIGATOR II Pay Plan: Career ServicePosition Number: Salary: $54,600 Annually...

  • Facility Manager

    1 week ago

    Orlando, Florida, United States Bags Inc. Full time

    Overview: Bags, a SP+ Company, is driven by Our Promise, Making Every Moment Matter for a World on the Go. Our team understands that time is scarce, so we are intentional about putting ourselves in the shoes of those we serve. The result is a unique combination of talented people and industry-leading technology that enables SP+ to prioritize each and every...

  • Nursing - Registered Nurse, Rehabilitation Nurse - Travel

    1 week ago

    Orlando, Florida, United States Apogee Solutions Full time

    Part Time Field Registered Nurse Apogee Solutions, a Woman-Owned Small Business, is seeking a Field Nurse (FN), RN Case Manager to support the United States Department of Labor (DOL) Nurse and Vocational Rehabilitation Services (NVRS) contract in the Orlando, FL area. Qualified candidates must be a US Citizen with the ability to pass a background...

  • AHMG Diabetes and Endocrinology at Orlando

    1 week ago

    Orlando, Florida, United States AdventHealth Central Florida Full time

    AdventHealth Medical Group is associated with the largest Protestant not-for-profit healthcare system in the world, AdventHealth and a national leader in quality, safety and patient satisfaction. AHMGs advanced practice providers manage the treatment and care for our patients in the practice setting, as well as at AdventHealths eleven campuses in Altamonte...

  • Physician (Pulmonary/ICU)-Section Chief

    13 hours ago

    Orlando, Florida, United States Veterans Affairs, Veterans Health Administration Full time

    Summary Orlando VA Healthcare System's Specialty Care Service is seeking an experienced and dynamic Pulmonary Section Chief. Ideal applicants are those who want to contribute to the achievement of quality care standards, as well as the growth and development of a VA academic hospital program. You must be an excellent communicator and team player who is...

  • APRN/PA Medical ICU

    1 week ago

    Orlando, Florida, United States AdventHealth Central Florida Full time

    AdventHealth Medical Group is associated with the largest Protestant not-for-profit healthcare system in the world, AdventHealth and a national leader in quality, safety and patient satisfaction. AHMG's advanced practice providers manage the treatment and care for our patients in the practice setting, as well as at AdventHealth's eleven campuses in Altamonte...

  • AHMG Neurology at Orlando

    3 weeks ago

    Orlando, Florida, United States AdventHealth Full time

    Overview AdventHealth Medical Group is associated with the largest Protestant not-for-profit healthcare system in the world, AdventHealth and a national leader in quality, safety and patient satisfaction. AHMG's advanced practice providers manage the treatment and care for our patients in the practice setting, as well as at AdventHealth's eleven campuses in...

  • AHMG Neurology at Orlando

    1 month ago

    Orlando, Florida, United States AdventHealth Full time

    Overview AdventHealth Medical Group is associated with the largest Protestant not-for-profit healthcare system in the world, AdventHealth and a national leader in quality, safety and patient satisfaction. AHMG's advanced practice providers manage the treatment and care for our patients in the practice setting, as well as at AdventHealth's eleven campuses in...

  • Construction Safety Loss Control Consultant

    1 week ago

    Orlando, Florida, United States Arthur J. Gallagher & Co. Full time

    Join our growing team of dedicated professionals at Gallagher Bassett, who guide those in need to the best possible outcomes for their health and wellbeing. You'll be part of a resilient team that works together to redefine the boundaries of excellence. At our organization, we value collaboration and making a positive impact in the lives of our clients and...

  • AHMG Cardiovascular Surgery PA-C or APRN-RNFA at Orlando

    1 week ago

    Orlando, Florida, United States AdventHealth Full time

    OverviewGeneral Summary: Under the direction and supervision of the surgeon, the Cardiovascular Surgery PA-C or APRN-RNFA will perform cardiovascular surgical preparation procedures, per-operative and post-operative procedures, and assists in performing cardiovascular surgical procedures. Provide patient and family with pre-operative education, answer...

  • AHMG Gyn Surgical Oncology

    1 month ago

    Orlando, Florida, United States AdventHealth Full time

    AdventHealth Medical Group is associated with the largest Protestant not-for-profit healthcare system in the world, AdventHealth and a national leader in quality, safety and patient satisfaction. AHMG's advanced practice providers manage the treatment and care for our patients in the practice setting, as well as at AdventHealth's eleven campuses in Altamonte...

  • AHMG Gyn Surgical Oncology

    3 weeks ago

    Orlando, Florida, United States AdventHealth Full time

    AdventHealth Medical Group is associated with the largest Protestant not-for-profit healthcare system in the world, AdventHealth and a national leader in quality, safety and patient satisfaction. AHMG's advanced practice providers manage the treatment and care for our patients in the practice setting, as well as at AdventHealth's eleven campuses in Altamonte...

  • AHMG Plastics and Reconstructive Surgery at Innovation Tower-APRN or PA-C

    1 week ago

    Orlando, Florida, United States AdventHealth Full time

    OverviewAdventHealth Medical Group is associated with the largest Protestant not-for-profit healthcare system in the world, AdventHealth and a national leader in quality, safety and patient satisfaction. AHMG's advanced practice providers manage the treatment and care for our patients in the practice setting, as well as at AdventHealth's eleven campuses in...

  • AHMG Thoracic Surgery Oncology at Orlando

    1 week ago

    Orlando, Florida, United States AdventHealth Full time

    OverviewAdventHealth Medical Group is associated with the largest Protestant not-for-profit healthcare system in the world, AdventHealth and a national leader in quality, safety and patient satisfaction. AHMG's advanced practice providers manage the treatment and care for our patients in the practice setting, as well as at AdventHealth's eleven campuses in...

  • Maintenance Technician II, High Performance Work Team

    1 week ago

    Orlando, Florida, United States University of Central Florida Full time

    UCF Facilities:The Facilities and Business Operations at UCF is dedicated to fostering a conducive educational environment for our faculty, staff, students, and the broader community. We are committed to excellence, providing unparalleled expertise, and maintaining a world-class standard in service.Please visit us at:Facebook: UCF FacilitiesInstagram: UCF...

  • Field Adjuster

    4 weeks ago

    Orlando, United States Heritage Property & Casualty Company Full time

    Follow and maintain claims management guidelines to determine insurance coverage by examining claimsforms, policies, and other records as appropriate. - Perform detailed investigations by coordinating field audits, and performing in-depth interviews Adjuster, Field, Claims Manager, Customer Service, Business Services

  • Medical Billing Specialist

    2 weeks ago

    Orlando, United States RHEUMATOLOGY ASSOCIATES Full time

    We are seeking a qualified and dedicated medical biller to join our office. In this position, you will be responsible for a variety of tasks. We are open to full or part time. **Medical Biller Responsibilities**: - Preparing and submitting billing data and medical claims to insurance companies. - Ensuring the patient’s medical information is accurate and...

  • Patient Accounting Spec Iii

    5 days ago

    Orlando, United States Orlando Health Full time

    Position Summary: The Patient Accounts Specialist III is responsible for coordinating efforts to resolve complex accounts and ensuring representatives’ interactions with patients are consistent and compassionate during billing and follow-up activities. This role is also responsible for collaborating with ancillary departments and third-party payers on...

  • Field Adjuster

    4 weeks ago

    Orlando, United States Heritage Insurance Full time

    Field Adjuster This role is open in Lee County, Orange County, Brevard County and Collier County. Job Summary: Analyzes and reviews claims for accuracy, completeness and eligibility. Resolves claims by investigating losses, calculating and negotiating settlements. Prepares and maintains reports and records for processing. Investigates, evaluates, reserves,...

  • Field Adjuster

    3 weeks ago

    Orlando, United States Heritage Insurance Full time

    Field Adjuster This role is open in Lee County, Orange County, Brevard County and Collier County. Job Summary: Analyzes and reviews claims for accuracy, completeness and eligibility. Resolves claims by investigating losses, calculating and negotiating settlements. Prepares and maintains reports and records for processing. Investigates, evaluates, reserves,...

  • Patient Accounting Spec Ii

    1 week ago

    Orlando, United States Orlando Health Full time

    Position Summary: At Orlando Health, we are ordinary people with extraordinary individuality, working together to bring help, healing and hope to those we serve. By daily embodying our over 100-year legacy, we have grown into a 3,900-bed healthcare organization that delivers care for more than 142,000 inpatient and 3.9 million outpatient visits each year....

  • Forensic Accounting Manager

    4 weeks ago

    Orlando, United States Meaden & Moore Full time

    Job DescriptionJob DescriptionDescriptionFirm:Meaden & Moore is a leading CPA and business consulting firm that is a seven-time winner of The Plain Dealer’s Top Workplaces, a six-time winner of Ohio Magazine’s Best Places to Work and awarded Inside Public Accounting's top 50 Best of Best Firms. All of these prestigious awards speaks to how our firm...

  • Forensic Accounting Manager

    4 weeks ago

    Orlando, United States Meaden & Moore Full time

    Job DescriptionJob DescriptionDescriptionFirm:Meaden & Moore is a leading CPA and business consulting firm that is a seven-time winner of The Plain Dealer’s Top Workplaces, a six-time winner of Ohio Magazine’s Best Places to Work and awarded Inside Public Accounting's top 50 Best of Best Firms. All of these prestigious awards speaks to how our firm...

  • Forensic Accounting Manager

    3 weeks ago

    Orlando, United States Meaden & Moore Full time

    Job DescriptionJob DescriptionDescriptionFirm:Meaden & Moore is a leading CPA and business consulting firm that is a seven-time winner of The Plain Dealer’s Top Workplaces, a six-time winner of Ohio Magazine’s Best Places to Work and awarded Inside Public Accounting's top 50 Best of Best Firms. All of these prestigious awards speaks to how our firm...

  • Forensic Accounting Manager

    3 weeks ago

    Orlando, United States Meaden & Moore Full time

    Job DescriptionJob DescriptionDescriptionFirm:Meaden & Moore is a leading CPA and business consulting firm that is a seven-time winner of The Plain Dealer’s Top Workplaces, a six-time winner of Ohio Magazine’s Best Places to Work and awarded Inside Public Accounting's top 50 Best of Best Firms. All of these prestigious awards speaks to how our firm...

  • Liability Defense Attorney II

    1 month ago

    Orlando, United States Geico Insurance Full time

    GEICO is looking to hire an Attorney II to defend lawsuits filed in Florida courts. The position is with GEICO Staff Counsel located in Orlando, FL. Job Responsibilities: * Researching laws and preparing legal briefs, opinions, and memoranda * Rendering opinions on liability, damages, and value as requested by the Claims Department * Preparing and...

  • Liability Defense Attorney II

    3 weeks ago

    Orlando, United States Geico Insurance Full time

    GEICO is looking to hire an Attorney II to defend lawsuits filed in Florida courts. The position is with GEICO Staff Counsel located in Orlando, FL. Job Responsibilities: * Researching laws and preparing legal briefs, opinions, and memoranda * Rendering opinions on liability, damages, and value as requested by the Claims Department * Preparing and...

  • Facility Manager

    3 weeks ago

    Orlando, United States Bags Full time

    Overview: Bags, a SP+ Company, is driven by Our Promise, “Making Every Moment Matter for a World on the Go.” Our team understands that time is scarce, so we are intentional about putting ourselves in the shoes of those we serve. The result is a unique combination of talented people and industry-leading technology that enables SP+ to prioritize each and...

  • Autotransfusionist

    2 weeks ago

    Orlando, United States Tryfacta Full time

    **Working Schedule**:7 AM to 03:30 PM (Monday - Friday) **Preferred shift, not mandatory**:On-call status for 24 hours a day and seven days a week including all Federal Holidays and be within 30 minutes of the facility to support these emergent cases. **Summary**: The Certified Auto transfusionist is responsible for providing autotransfusion services in...

  • Facility Manager

    3 weeks ago

    Orlando, United States Bags Full time

    Overview Bags, a SP+ Company, is driven by Our Promise, “Making Every Moment Matter for a World on the Go.” Our team understands that time is scarce, so we are intentional about putting ourselves in the shoes of those we serve. The result is a unique combination of talented people and industry-leading technology that enables SP+ to prioritize each...

  • Facility Manager

    3 weeks ago

    Orlando, United States Bags Full time

    Job DescriptionJob DescriptionOverviewBags, a SP+ Company, is driven by Our Promise, “Making Every Moment Matter for a World on the Go.” Our team understands that time is scarce, so we are intentional about putting ourselves in the shoes of those we serve. The result is a unique combination of talented people and industry-leading technology that enables...

  • Forensic Accounting Intern

    3 weeks ago

    Orlando, United States Meaden & Moore Full time

    Job DescriptionJob DescriptionDescriptionMeaden & Moore is a leading CPA and business consulting firm that is a seven-time winner of The Plain Dealer’s Top Workplaces, a six-time winner of Ohio Magazine’s Best Places to Work and awarded Inside Public Accounting's top 50 Best of Best Firms. All of these prestigious awards speaks to how our firm is ran...

  • Forensic Accounting Intern

    1 month ago

    Orlando, United States Meaden & Moore Full time

    Job DescriptionJob DescriptionDescriptionMeaden & Moore is a leading CPA and business consulting firm that is a seven-time winner of The Plain Dealer’s Top Workplaces, a six-time winner of Ohio Magazine’s Best Places to Work and awarded Inside Public Accounting's top 50 Best of Best Firms. All of these prestigious awards speaks to how our firm is ran...

  • Registered Nurse, Community Outreach $1000 Sign On Incentive

    1 month ago

    Orlando, United States Orange County, FL Full time

    Registered Nurse, Community Outreach $1000 Sign On IncentiveOverview This position will be located at the Orange County Medical Clinic with their Community Outreach program. Representative Duties For the Medical Clinic duties will include: Will work closely with the program manager and RN partner to assist with all aspects of the Community Outreach...

  • Registered Nurse, Community Outreach $1000 Sign On Incentive

    3 weeks ago

    Orlando, United States Orange County, FL Full time

    Registered Nurse, Community Outreach $1000 Sign On IncentiveOverview This position will be located at the Orange County Medical Clinic with their Community Outreach program. Representative Duties For the Medical Clinic duties will include: Will work closely with the program manager and RN partner to assist with all aspects of the Community Outreach...