Claims Examiner

4 weeks ago

Trenton, New Jersey, United States Sedgwick Full time

Transforming Claims Management with Expertise

Sedgwick is seeking a skilled Claims Examiner to join our team. As a Claims Examiner, you will play a critical role in analyzing complex liability claims, ensuring timely and cost-effective resolution, and providing exceptional service to our clients.

Key Responsibilities:

  • Analyze complex liability claims, investigating and gathering information to determine exposure and develop effective action plans.
  • Assess liability and resolve claims within evaluation, negotiating settlements within designated authority.
  • Calculate and assign timely and appropriate reserves to claims, managing reserve adequacy throughout the claim's life cycle.
  • Prepare necessary state filings within statutory limits, ensuring compliance with regulatory requirements.
  • Manage the litigation process, ensuring timely and cost-effective claims resolution, and coordinate vendor referrals for additional investigation and/or litigation management.
  • Use appropriate cost containment techniques, including strategic vendor partnerships, to reduce overall claim costs for our clients.
  • Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
  • Report claims to the excess carrier, responding to requests and directions in a professional and timely manner.
  • Communicate claim activity and processing with the claimant and client, maintaining professional client relationships.
  • Ensure claim files are properly documented and claims coding is correct, referring cases as appropriate to supervisor and management.

Requirements:

  • Bachelor's degree from an accredited college or university, preferably with professional certification relevant to the line of business.
  • Five (5) years of claims management experience or an equivalent combination of education and experience.
  • Subject matter expertise in insurance principles and laws, recoveries offsets and deductions, claim and disability duration, cost containment principles, and Social Security and Medicare application procedures.
  • Excellent oral and written communication, including presentation skills, and PC literacy, including Microsoft Office products.
  • Strong analytical and interpretive skills, with the ability to work in a team environment and meet or exceed Service Expectations.

About Sedgwick:

Sedgwick is a leading global provider of technology-enabled risk, benefits, and integrated business solutions. Our team of over 30,000 colleagues across 80 countries is dedicated to helping organizations protect their employees, manage claims, and minimize business interruptions. We are committed to doing the right thing, one where caring counts.

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