Liability Claims Analyst

2 weeks ago

Jefferson City, Missouri, United States Sedgwick Full time

Overview: At Sedgwick, we prioritize the well-being of our employees, fostering a culture that emphasizes care and support. We believe in providing a flexible work environment that allows you to balance your professional and personal life effectively.

Purpose of the Role: The primary responsibility of the Claim Examiner is to evaluate intricate general liability claims, ensuring that all benefits are accurately determined. This role involves managing high-stakes claims that may include litigation and rehabilitation processes, while adhering to industry standards and client expectations.

Key Responsibilities:

  • Conduct thorough investigations to assess complex general liability claims, developing strategic action plans for timely resolutions.
  • Evaluate liability and resolve claims within established guidelines.
  • Negotiate settlements within the authority limits provided.
  • Determine and maintain appropriate reserves throughout the claims process.
  • Process and authorize timely payments and adjustments for claims.
  • Prepare necessary documentation in compliance with state regulations.
  • Oversee the litigation process to ensure efficient and cost-effective resolutions.
  • Coordinate with external vendors for additional investigations or litigation management.
  • Implement cost containment strategies to minimize overall claims expenses.
  • Manage recovery processes, including subrogation and offsets related to Social Security and Medicare.
  • Maintain professional communication with claimants and clients regarding claim status and processing.
  • Ensure accurate documentation and coding of claims files.
  • Refer complex cases to management as necessary.

Additional Duties:

  • Perform other assigned tasks as needed.
  • Support the organization's quality assurance initiatives.
  • Travel may be required as part of the role.

Qualifications:

Education: A bachelor's degree from an accredited institution is preferred. Relevant professional certifications are advantageous.

Experience: A minimum of five years in claims management or a related field is required.

Skills and Knowledge:

  • Expertise in insurance principles and regulations relevant to the claims process.
  • Strong communication skills, both verbal and written.
  • Proficient in Microsoft Office and other relevant software.
  • Analytical and problem-solving abilities.
  • Excellent organizational and interpersonal skills.
  • Proficient negotiation capabilities.
  • Able to work collaboratively within a team.
  • Consistently meet service expectations.

Work Environment: Sedgwick is committed to providing reasonable accommodations when necessary. The role requires mental acuity for problem-solving and the ability to manage multiple priorities effectively. Physical requirements include keyboarding and occasional travel.

Note: A background credit check is required for this position. Sedgwick is an Equal Opportunity Employer and maintains a drug-free workplace.

Core Values: At Sedgwick, we believe in the importance of caring for our colleagues and clients alike. Our mission is to provide exceptional service while fostering a supportive and inclusive work environment.

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