Subrogation Examiner Roseville, Ca or San Diego, Ca

3 weeks ago

Roseville, 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.

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Subrogation Examiner | Roseville, CA or San Diego, CA | In-Office or Hybrid
- 3 to 5 years’ liability claims experience minimum with base knowledge of Workers' Compensation
- Be able to provide guidance to the work comp team as to what information is needed during their investigation into potential subro recovery from a third party
- Understanding of liability claim/laws in order to make determination of our potential to obtain recovery as well as how to deal with civil court statutes
- Able to work independently but also understand the importance of team work with the work comp team as well as the clients.
- Ability to work in a paperless environment as well as understanding of working in Excel, Power Point, etc
- Excellent time management skills with an understanding of the importance of meeting client required time frames as well as statutory time frames
- PRIMARY PURPOSE: Analyzes and processes complex claims, works with high exposure claims involving litigation, and ensures ongoing claims within service expectations, industry best practices and specific client service requirements. Identifies and pursues potential third-party subrogation recoveries associated with highest exposure/complexity claims, all lines of business across all jurisdictions.
- ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Reviews high exposure, complex multi-jurisdictional claims to establish potential for third party subrogation recovery by investigating and gathering information based on feasibility of recovery analysis and employment of strategies to manage the claim through timely resolution.
- Provides subrogation guidance and direction to both internal and external stakeholders to maximize recovery efforts in alignment with client, financial and jurisdictional strategy, and guidelines.
- Develops and pursues third party subrogation, refers assignments to subrogation counsel as dictated by statute or timeline, and discusses any compromised or negotiation of the claimed subrogation interest.
- Sends appropriate subrogation lien notifications to appropriate parties.
- Gathers information necessary to support viable subrogation claims; documents claim notes with appropriate information.
- Provides direction to assigned subrogation counsel.
- Maintains a diary on active claims with subrogation potential and claims that meet excess reporting criteria; ensures claim files are properly documented and claims coding is correct.
- Approves and makes timely claim payments relative to subrogation and settles complex/high exposure claims within designated client authority level.
- Manages claim recoveries, including but not limited to subrogation; secures recovery from responsible parties; enters recovery fees into claims management system.
- Prepares status reports for clients as required and presents in claims reviews.
- Provides additional layer subrogation expertise to peers and participates in team preparation for client reviews.
- Manages the litigation process; ensures timely and cost-effective resolution.
- Coordinates vendor referrals for additional investigation and/or litigation management.
- Develops training material and leads department training opportunities.
- Uses appropriate cost containment techniques, including strategic vendor partnerships, to reduce overall cost of claims for our clients.
- Assists in gathering important compliance/claims processing information to be presented at team meetings.
- Provides mentorship and training to colleagues within unit.
- ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Travels as required.
- QUALIFICATIONS
- Education & Licensing
Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.
- Experience
Six (6) years of multi-jurisdictional liability (general liability, auto liability, products), subrogation and/or workers compensation claims handling experience or e

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