Insurance Claims Specialist

2 weeks ago

Lansing, Michigan, United States Sedgwick Full time

PRIMARY OBJECTIVE:
To evaluate and manage intricate auto and commercial transportation claims by assessing coverage, conducting investigations, determining liability, and appraising the extent of damages.

KEY RESPONSIBILITIES:

  • Handles complex auto and commercial claims, including bodily injury, ensuring accurate documentation and coding of claim files.
  • Oversees the litigation process for litigated claims.
  • Coordinates vendor management, including engaging independent adjusters to aid in claim investigations.
  • Reports significant claims to excess carriers.
  • Develops and maintains action plans to meet state-required contact deadlines and facilitate prompt and appropriate resolutions.
  • Identifies and pursues subrogation and risk transfer opportunities; manages salvage processes.
  • Communicates claim actions and processing updates with insured parties, clients, and agents or brokers as necessary.

ADDITIONAL DUTIES:
Performs other assigned responsibilities, supports the organization's quality initiatives, and travels as needed.

QUALIFICATIONS:

Education & Licensing:
Bachelor's degree from an accredited institution is preferred. Professional certification relevant to the line of business is also preferred. Must secure and maintain state adjusting licenses as required for the role.

Experience:
A minimum of five (5) years in claims management or an equivalent combination of education and experience is required, including comprehensive knowledge of personal and commercial auto policies, coverages, principles, and regulations.

Skills & Knowledge:
• In-depth understanding of personal and commercial auto policies, coverages, principles, and regulations.
• Familiarity with medical terminology for claim assessment and Medicare compliance.
• Knowledge of the application of deductibles, sub-limits, SIRs, carrier, and large deductible programs.
• Strong oral and written communication skills, including presentation abilities.
• Proficient in PC applications, including Microsoft Office Suite.
• Excellent organizational and interpersonal skills.
• Effective negotiation capabilities.
• Ability to collaborate within a team environment.
• Capability to meet or exceed service expectations.

WORK ENVIRONMENT:
Consideration will be given to reasonable accommodations when applicable and appropriate.

Mental:
Requires clear and conceptual thinking, excellent judgment, problem-solving skills, and the ability to manage work-related stress while handling multiple priorities and meeting deadlines.

Physical:
Involves computer keyboarding and travel as required.

Auditory/Visual:
Requires hearing, vision, and verbal communication.

NOTE:
A credit security clearance, confirmed via a background credit check, is necessary for this position.

The information contained in this document is intended to describe the general nature and level of work performed by an employee in this role. It is not a comprehensive list of functions, duties, or local variations. Management retains the discretion to modify the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and maintains a Drug-Free Workplace.

If you are enthusiastic about this role but feel your experience does not align perfectly with every qualification, we encourage you to apply anyway. Sedgwick is committed to building a diverse, equitable, and inclusive workplace and recognizes that each individual brings a unique combination of skills, knowledge, and experience.

At Sedgwick, taking care of people is our core mission. Caring counts.

Sedgwick is a leading global provider of technology-enabled risk, benefits, and integrated business solutions. Every day, renowned organizations trust us to assist their employees in regaining health and productivity, navigate the claims process, protect their brand, and minimize business interruptions.

Our more than 30,000 colleagues across 80 countries embody our shared purpose and values, demonstrating what it means to work for an organization dedicated to doing the right thing – where caring counts.

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