Claims Adjuster

2 weeks ago


Carson City, Nevada, United States Sedgwick Full time
About the Role

Sedgwick is seeking a skilled Claims Adjuster - Liability to join our team. As a Claims Adjuster - Liability, you will play a critical role in analyzing and resolving mid- and higher-level general liability claims. Your expertise will ensure that claims are handled efficiently and effectively, while maintaining a high level of customer satisfaction.

Key Responsibilities
  • Analyze and evaluate general liability claims to determine benefits due and ensure ongoing adjudication within company standards and industry best practices.
  • Manage mid-level general liability claims by gathering information to determine liability exposure, assigning reserve values, making claims payments as necessary, and settling claims up to designated authority level.
  • Assess liability and resolve claims within evaluation, ensuring that all necessary documentation is properly maintained.
  • Approve and process assigned claims, determine benefits due, and manage action plans pursuant to the claim or client contract.
  • Manage subrogation of claims and negotiate settlements, ensuring that all parties are satisfied with the outcome.
  • Communicate claim actions with claimants and clients, providing clear and concise information to ensure understanding.
  • Ensure claim files are properly documented and claims coding is correct, maintaining accurate and up-to-date records.
  • May process complex lifetime medical and/or defined period medical claims, including state and physician filings and decisions on appropriate treatments recommended by utilization review.
  • Maintain professional client relationships, building trust and ensuring that clients receive exceptional service.
Requirements
  • Bachelor's degree from an accredited college or university preferred.
  • Four (4) years of claims management experience or equivalent combination of education and experience required.
  • 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

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. We offer a comprehensive benefits package, including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

We are committed to creating a diverse, equitable, and inclusive workplace, where every colleague feels valued and empowered to contribute their best work. If you're excited about this role and believe you have the skills and experience to succeed, we encourage you to apply.


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