General Liability Adjuster

Sedgwick•Telecommuter FL, FL

About The Position

The General Liability Adjuster analyzes mid- and higher-level general liability claims to determine benefits due, ensure claims are adjudicated in line with company standards and industry best practices, identify subrogation opportunities, and negotiate settlements. The role manages claims from information gathering and liability assessment through reserves, payments, settlement, documentation, and communication with claimants and clients. It may also involve complex lifetime medical or defined-period medical claims, including state and physician filings and decisions about treatments recommended by utilization review. The position maintains professional client relationships, supports quality programs, travels as required, and performs other assigned duties. Sedgwick describes its culture as caring and supportive of work-life balance and is an equal opportunity employer and drug-free workplace. Reasonable accommodations will be considered when applicable and appropriate.

Requirements

Four years of claims management experience, or an equivalent combination of education and experience.
New York license required.
Subject matter expertise in appropriate insurance principles and laws for 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.
PC 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 handle work-related stress and multiple priorities simultaneously, meet deadlines, and exercise judgment, troubleshooting, problem-solving, analysis, and discretion.
Ability to perform computer keyboarding and, when required, travel; hearing, vision, and talking are also required.

Nice To Haves

Bachelor's degree from an accredited college or university preferred.

Responsibilities

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