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Complex Claims Analyst

2 months ago

Michigan, United States Sedgwick Full time

At Sedgwick, we prioritize the well-being of our team members, ensuring a supportive environment where you can thrive both personally and professionally. Our commitment to a culture of care means that you will have the flexibility to balance your work and personal life while engaging in meaningful work that positively impacts others.

PRIMARY PURPOSE: The role involves evaluating intricate general liability claims to ascertain the benefits owed. You will handle high-stakes claims that may involve legal proceedings and rehabilitation efforts, ensuring claims are processed in line with service expectations, industry standards, and specific client requirements. Additionally, you will identify opportunities for subrogation and negotiate settlements effectively.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

  • Conduct thorough analysis and processing of complex general liability claims by gathering pertinent information to assess claim exposure; manage claims with well-structured action plans for timely resolution.
  • Evaluate liability and resolve claims efficiently.
  • Negotiate settlements within your designated authority.
  • Determine and assign appropriate reserves for claims; oversee reserve adequacy throughout the claim's lifecycle.
  • Calculate and disburse benefits owed; ensure timely payments and adjustments are made, settling claims within your authority level.
  • Prepare necessary state filings within legal limits.
  • Oversee the litigation process to ensure efficient and cost-effective claims resolution.
  • Coordinate vendor referrals for further investigation or litigation management.
  • Implement cost containment strategies, including strategic partnerships with vendors to minimize overall claims costs for clients.
  • Manage claim recoveries, including subrogation and offsets related to Social Security and Medicare.
  • Report claims to excess carriers and respond to inquiries professionally and promptly.
  • Maintain communication regarding claim activity with claimants and clients, fostering professional relationships.
  • Ensure accurate documentation of claim files and correct coding.
  • Refer cases to supervisors and management as necessary.

ADDITIONAL FUNCTIONS AND RESPONSIBILITIES:

  • Perform other assigned duties.
  • Support the organization's quality initiatives.
  • Travel as needed.

QUALIFICATIONS:

Education & Licensing: A bachelor's degree from an accredited institution is preferred. Relevant professional certification is also desirable.

Experience: A minimum of five years in claims management or a comparable combination of education and experience is required.

Skills & Knowledge:

  • Expertise in insurance principles and laws relevant to the claims process, including recovery offsets and deductions.
  • Strong oral and written communication skills, including the ability to present information effectively.
  • Proficient in Microsoft Office and other relevant software.
  • Analytical and interpretive capabilities.
  • Excellent organizational skills.
  • Strong interpersonal abilities.
  • Exceptional negotiation skills.
  • Ability to collaborate effectively within a team.
  • Commitment to meeting or exceeding service expectations.

WORK ENVIRONMENT: Reasonable accommodations will be considered when applicable.

Mental: Requires clear thinking, sound judgment, problem-solving abilities, and the capacity to manage work-related stress while handling multiple priorities and meeting deadlines.

Physical: Involves keyboarding and travel as necessary.

Auditory/Visual: Requires hearing, vision, and verbal communication.

NOTE: A background credit check is required for this position.

At Sedgwick, we are committed to fostering a diverse and inclusive workplace. We encourage individuals with unique skills and experiences to consider applying, even if they do not meet every qualification listed.