Claims Examiner

2 weeks ago

Overland Park, 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 - Liability

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

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.

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.

  • Claims Team Lead

    2 weeks ago

    Overland Park, 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...

  • Claims Supervisor

    2 weeks ago

    Overland Park, United States CorVel Enterprise Comp, Inc. Full time

    Job DescriptionJob DescriptionThe Claims Supervisor is responsible for supervising a team of direct reports, ensuring all quality, productivity and customer service criteria are met while adhering to company policies and procedures. The Claims Supervisor position is integral to the success of the company and requires regular and consistent attendance,...

  • Casualty Claims Director

    3 weeks ago

    Bedford Park, United States First Chicago Insurance Company (FCIC) Full time

    If you are an experienced **CLAIMS PROFFESSIONAL** (with many years of auto and especially nonstandard auto related experience) we'll make sure you are **COMPENSATED AS A PROFFESSIONAL!!** **We are seeking an experienced Casualty Director!** The Casualty Claims Director will be responsible for the direct supervision of the Casualty Claims unit. Scope of...

  • Seeking Retired Insurance Claims Professionals

    2 weeks ago

    Bedford Park, United States First Chicago Insurance Company (FCIC) Full time

    **Are you a retired Claims Professional looking to get back in the insurance claims business?** We are seeking experienced Auto Bodily Injury Claims Professionals and Auto Liability Claims Professionals! Part-time and Full-time Opportunities Available! If you are an experienced **CLAIMS PROFFESSIONAL** (with many years of auto and especially nonstandard...

  • Seeking Retired Insurance Claims Professionals

    3 weeks ago

    Bedford Park, United States Warrior Insurance Network Full time

    Are you a retired Claims Professional looking to get back in the insurance claims business? We are seeking experienced Auto Bodily Injury Claims Professionals and Auto Liability Claims Professionals! Part-time and Full-time Opportunities Available! If you are an experienced CLAIMS PROFFESSIONAL (with many years of auto and especially nonstandard auto...

  • Seeking Retired Insurance Claims Professionals

    3 weeks ago

    Bedford Park, United States First Chicago Insurance Company Full time

    Are you a retired Claims Professional looking to get back in the insurance claims business? We are seeking experienced Auto Bodily Injury Claims Professionals and Auto Liability Claims Professionals! Part-time and Full-time Opportunities Available!If you are an experienced CLAIMS PROFFESSIONAL (with many years of auto and especially nonstandard auto related...

  • Field Appraiser-Auto Claims

    1 month ago

    Bedford Park, United States First Chicago Insurance Company (FCIC) Full time

    We are seeking an experienced Auto Claims Field Appraiser!The Auto Claims Field Appraiser will provide specialized technical work involving the interpretation of damage in order to formulate estimate of damage, unrelated prior damage, and determination of total losses. DUTIES AND RESPONSIBILITIES:Examines damaged vehicles to determine extent of structural,...

  • Auto Claims Supervisor

    2 weeks ago

    Bedford Park, United States Warrior Insurance Network Full time

    We are Growing!Coming Soon-Claims Office Opening in Oak Brook!We are Warrior Insurance Network! We have offices in Bedford Park, IL, (about one mile south of Chicago Midway Airport), as well as Richardson, Texas (Dallas area). Due to our significant growth, we are pleased to announce that we are opening a new Claims office in Oak Brook! Are you a seasoned...

  • Cook (PT/Evening)

    1 month ago

    Overland Park, United States Delmar Gardens Full time

    - Cook (PT/Evening) **Delmar Gardens of Overland Park** is seeking a **Part-Time Cook** with experience in large volume cooking. The successful candidate will assist in preparing breakfast, lunch, and dinner for our residents. Prior experience in hospitals, hotels, banquet, or senior housing a plus!**Disclaimer** **1.** If I am offered employment, I...

  • Personal Trainer

    3 weeks ago

    Overland Park, United States Ultimate Performance Full time

    Personal Trainer - SydneyDescriptionDo you know how it feels to help others and be a part of a team that is revolutionising an industry? We are not just looking for someone who wants a job but someone who is genuinely passionate about furthering their career in a growing company.Working at Ultimate Performance (U.P.) means a singular focus on mastering your...

  • Property Damage Subrogation Specialist

    4 weeks ago

    Bedford Park, United States Warrior Insurance Network Full time

    The PD Subrogation Specialist will be responsible for the handling and resolution of all collectable auto property damage subrogation claims. Must have the ability to determine, develop and negotiate the theory of liability with Third Party carriers, attorneys, and uninsured motorists, as well as resolve files in accordance with company objectives and...

  • Property Damage Subrogation

    4 weeks ago

    Bedford Park, United States First Chicago Insurance Company (FCIC) Full time

    The PD Subrogation Specialist will be responsible for the handling and resolution of all collectable auto property damage subrogation claims. Must have the ability to determine, develop and negotiate the theory of liability with Third Party carriers, attorneys, and uninsured motorists, as well as resolve files in accordance with company objectives and...

  • Property Damage Subrogation Supervisor

    2 weeks ago

    Bedford Park, United States First Chicago Insurance Company (FCIC) Full time

    **W**e are seeking a Property Damage Subrogation Supervisor!** The PD Subrogation Supervisor will be responsible for supervising a team of two - three Subrogation Specialists, dealing with collections and third-party property damage claims. The Supervisor will have their own claims files to handle and be responsible for the handling and resolution of all...

  • Property Damage Subrogation Supervisor

    2 weeks ago

    Bedford Park, United States Warrior Insurance Network Full time

    **We are seeking a Property Damage Subrogation Supervisor!** The PD Subrogation Supervisor will be responsible for supervising a team of two - three Subrogation Specialists, dealing with collections and third-party property damage claims. The Supervisor will have their own claims files to handle and be responsible for the handling and resolution of all...

  • Senior Financial Analyst

    7 days ago

    Overland Park, United States IMA Financial Group Full time

    What You'll Do Lead the process of implementation of new and existing partners into the IMA ecosystem in terms of Accounting & Finance, including project management of systems, GL codes, reporting and basic integration Contribute to the corporate annual budget process and provides periodic forecasting as needed Execute partner-related reports with careful...

  • Customer Service Representative

    9 hours ago

    Ridgefield Park, United States ektello Full time

    Voice of the Customer(VOC) Admin **6-month W2 Contract**Ridgefield Park, NJ**ONSITE**$18-24/hr** Purpose Of Position VOC Admin (Legal cases (Attorney General (AG)/Small Claims)) coordinates and assigns to relevant party to follow up for resolution Working closely with Legal team for AG responses/Small claims Claim root cause analysis and register in GCIC...

  • Litigation Specialist-Hybrid Opportunities Available

    3 weeks ago

    Bedford Park, United States Warrior Insurance Network Full time

    If you are an experienced CLAIMS PROFFESSIONAL (with many years of auto and especially nonstandard auto related experience) we'll make sure you are COMPENSATED AS A PROFFESSIONAL!!We are seeking an experienced Litigation Claims Specialist!The Litigation Specialist will be responsible for handling litigated and/or complex injury claims stemming from Personal...

  • Litigation Specialist-Hybrid Opportunities Available

    3 weeks ago

    Bedford Park, United States First Chicago Insurance Company (FCIC) Full time

    If you are an experienced CLAIMS PROFFESSIONAL (with many years of auto and especially nonstandard auto related experience) we'll make sure you are COMPENSATED AS A PROFFESSIONAL!!We are seeking an experienced Litigation Claims Specialist!The Litigation Specialist will be responsible for handling litigated and/or complex injury claims stemming from Personal...

  • Credit Analyst

    2 weeks ago

    Ridgefield Park, United States DHD Consulting Full time

    Position: Credit Analyst Job specifications include, but are not limited to: [Insurance portfolio management] Managing Trade credit insurance portfolios with team members. Examine insurance policy documents and advise insurance risk management solutions to solve complex business issues, working closely with the legal and business teams. Advise and prepare...

  • Credit Analyst

    2 weeks ago

    Ridgefield Park, United States DHD Consulting Full time

    Position: Credit Analyst Job specifications include, but are not limited to: [Insurance portfolio management] Managing Trade credit insurance portfolios with team members. Examine insurance policy documents and advise insurance risk management solutions to solve complex business issues, working closely with the legal and business teams. Advise and prepare...