Claims Examiner, Auto | PIP | Litigation Required
About The Position
By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance PRIMARY PURPOSE OF THE ROLE To analyze complex or technically difficult Personal Injury Protection Claims to determine benefits due; to work with high exposure claims involving litigation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
Requirements
- Five (5) years of claims management experience or equivalent combination of education and experience required.
- excellent oral and written communication, including presentation skills, PC literate including Microsoft Office products, analytical and interpretive skills, excellent negotiation skills, ability to work in a team environment and meet or exceed Service Expectations
Nice To Haves
- Bachelor's degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
Responsibilities
- Analyzes and processes complex or technically difficult third party property liability claims and personal injury protection claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Negotiates settlement of claims within designated authority.
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
- Prepares necessary state fillings within statutory limits.
- Manages the litigation process; ensures timely and cost effective claims resolution.
- Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
- Ensures claim files are properly documented and claims coding is correct.
- Refers cases as appropriate to supervisor and management.
- Performs other duties as assigned.
Benefits
- medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
