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Claims Adjuster
2 months ago
We are seeking a highly skilled Claims Adjuster - Risk Management Specialist to join our team at Sedgwick. As a key member of our liability claims team, you will be responsible for processing low-level general liability claims, determining benefits due, and ensuring ongoing adjudication of claims within company standards and industry best practices.
Key Responsibilities- Process low-level general liability claims by gathering information to determine liability exposure, assigning reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
- Develop and coordinate low-level general liability claims' action plans to resolution, return-to-work efforts, and approve claim payments.
- Approve and process assigned claims, determine benefits due, and administer action plan pursuant to the claim or client contract.
- Administer subrogation of claims and negotiate settlements.
- Communicate claim action with claimant and client.
- Ensure claim files are properly documented and claims coding is correct.
- May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
- Maintain professional client relationships.
- Bachelor's degree from an accredited college or university preferred.
- Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.
- Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure 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.
- Ability to work in a team environment.
- Ability to meet or exceed Service Expectations.
When applicable and appropriate, consideration will be given to reasonable accommodations.
The successful candidate will be required to undergo a background credit check and obtain a credit security clearance.
