Claims Adjuster, Auto | Liability

Sedgwick•Telecommuter TX, TX

21h

About The Position

The Claims Adjuster analyzes mid- and higher-level general liability claims to determine benefits due, ensure ongoing adjudication within company standards and industry best practices, identify subrogation opportunities, and negotiate settlements. The role manages claims from evaluation through resolution, maintains claim documentation and coding, communicates with claimants and clients, and supports the organization's quality programs. It may also involve processing complex lifetime medical or defined-period medical claims, including state and physician filings and decisions on treatments recommended by utilization review.

Requirements

Four years of claims management experience or an equivalent combination of education and experience.
Expert knowledge of insurance principles and laws applicable to the 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.
Excellent oral and written communication skills, including presentation skills.
Computer literacy, 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.
Ability to perform computer keyboarding.
Ability to hear, see, and talk.
Clear and conceptual thinking ability, excellent judgment and discretion, and ability to meet deadlines.

Nice To Haves

Bachelor's degree from an accredited college or university.

Responsibilities

Gather information to determine liability exposure for mid-level general liability claims.
Assign reserve values, make claims payments as necessary, and settle claims within designated authority levels.
Assess liability and resolve claims within evaluation.
Approve and process assigned claims, determine benefits due, and manage action plans under the claim or client contract.
Manage claim subrogation and negotiate settlements.
Communicate claim actions with claimants and clients.
Ensure claim files are properly documented and claims coding is correct.
May process complex lifetime medical or defined-period medical claims, including state and physician filings and decisions about treatments recommended by utilization review.
Maintain professional client relationships.
Perform other duties as assigned.
Support the organization's quality program(s).