Claims Examiner

3 days ago

Baton Rouge, Louisiana, United States Sedgwick Full time
Job Summary

Sedgwick is seeking a highly skilled Claims Examiner - Liability to join our team. As a key member of our claims team, you will be responsible for analyzing complex general liability claims, determining benefits due, and ensuring timely and cost-effective claims resolution.

Key Responsibilities
  • Analyze and process complex general liability claims, investigating and gathering information to determine exposure and develop well-planned action plans for resolution.
  • Assess liability and resolve claims within evaluation, negotiating settlements within designated authority levels.
  • 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 and manage the litigation process to ensure timely and cost-effective claims resolution.
  • Coordinate vendor referrals for additional investigation and/or litigation management, utilizing cost containment techniques to reduce overall claim costs.
  • Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
  • Communicate claim activity and processing with claimants and clients, maintaining professional relationships and ensuring claim files are properly documented and coded.
Requirements
  • Bachelor's degree from an accredited college or university, with professional certification in the line of business preferred.
  • Five (5) years of claims management experience or equivalent combination of education and experience required.
  • 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 analytical and interpretive skills.
  • PC literate, including Microsoft Office products, and ability to work in a team environment.
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, guide their consumers through the claims process, and minimize business interruptions. We are committed to doing the right thing and making a positive impact on the world through the people and organizations we serve.

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