Claims Examiner, Auto | Bodily Injury

Sedgwick•Telecommuter FL, FL

About The Position

The Claims Examiner analyzes complex or technically difficult auto and general liability claims to determine benefits due. The role handles high-exposure claims involving litigation and rehabilitation, ensures ongoing adjudication within service expectations, industry best practices, and client requirements, and identifies subrogation opportunities and negotiates settlements. The position investigates claims, evaluates liability and exposure, establishes and manages reserves, calculates and pays benefits, prepares required state filings, and manages litigation through timely and cost-effective resolution. It also coordinates vendors, applies cost-containment techniques, manages recoveries and excess-carrier reporting, communicates claim activity with claimants and clients, maintains accurate claim files and coding, and supports the organization's quality programs.

Requirements

Five years of claims management experience, or an equivalent combination of education and experience.
In-depth knowledge of personal and commercial line auto policies, coverages, principles, and laws.
Strong oral and written communication skills, including presentation skills.
PC literacy, including Microsoft Office products.
Ability to work in a team environment.
Ability to secure and maintain state adjusting licenses as required for the position.
Ability to meet deadlines, exercise excellent judgment and discretion, and think clearly and conceptually.

Nice To Haves

Bachelor's degree from an accredited college or university.
Professional certification applicable to the line of business.

Responsibilities

Investigates and gathers information on complex or technically difficult general liability claims to determine exposure and manages claims through action plans to appropriate, timely resolution.
Assesses liability and resolves claims within evaluation.
Negotiates claim settlements within designated authority.
Calculates and assigns timely, appropriate reserves and monitors reserve adequacy throughout the life of the claim.
Calculates and pays benefits, approves and makes timely claim payments and adjustments, and settles claims within designated authority.
Prepares necessary state filings within statutory limits.
Manages the litigation process to ensure timely and cost-effective claims resolution.
Coordinates vendor referrals for additional investigation and litigation management.
Uses cost-containment techniques, including strategic vendor partnerships, to reduce overall claim costs for clients.
Manages claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
Reports claims to the excess carrier and responds to requests for directions professionally and promptly.
Communicates claim activity and processing with claimants and clients and maintains professional client relationships.
Ensures claim files are properly documented and claim coding is correct.
Refers cases to a supervisor or management as appropriate.
Performs other duties as assigned.
Supports the organization's quality programs.