Sedgwick logo
Sedgwick

Sedgwick, headquartered in Memphis, Tennessee, provides a global clientele with technology-enabled risk and benefits solutions. Distinguished as an Employer of

Claims Examiner, Auto, Bodily Injury, GL

Claims SpecialistClaims SpecialistFull TimeRemoteSeniorTeam 10,001Company Site

Location

Wisconsin

Posted

15 days ago

Salary

$70K - $75K / year

Seniority

Senior

Bachelor Degree5 yrs expEnglish

Job Description

• To analyze complex or technically difficult general liability claims to determine benefits due • To work with high exposure claims involving litigation and rehabilitation • To ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements • To identify subrogation of claims and negotiate settlements • Analyzes and processes complex or technically difficult general liability 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 • Assesses liability and resolves claims within evaluation • 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 claims within designated authority level • Prepares necessary state fillings within statutory limits • Manages the litigation process; ensures timely and cost effective claims resolution • Coordinates vendor referrals for additional investigation and/or litigation management • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients • Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner • 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

Job Requirements

  • Bachelor's degree from an accredited college or university preferred
  • Professional certification as applicable to line of business preferred
  • Five (5) years of claims management experience or equivalent combination of education and experience required
  • Subject matter expert of appropriate insurance principles and laws for 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 to line-of-business
  • Excellent oral and written communication, including presentation skills
  • PC literate, 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

Benefits

  • medical, dental, vision
  • 401k and matching
  • PTO
  • disability and life insurance
  • employee assistance
  • flexible spending or health savings account
  • other additional voluntary benefits

Related Categories

Related Job Pages

More Claims Specialist Jobs

Full TimeRemoteTeam 5,001-10,000

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we CARE through our values, Sustainability initiatives and inclusive corporate culture . Our Property Claims...

United States
NTT DATA logo

Medical Claims Processor, Remote Temporary

NTT DATA

NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. Our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D.

Claims Specialist15 days ago
Full TimeRemoteTeam 10,001

The associate will be responsible for processing professional claim forms, reviewing policies and benefits, and ensuring compliance with HIPAA and confidentiality regulations. Key duties include working independently to research, review, and adjudicate claims according to defined workflows and meeting strict productivity and quality targets.

United States
NTT DATA logo

Medical Claims Processor, Remote Temporary

NTT DATA

NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. Our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D.

Claims Specialist15 days ago
Full TimeRemoteTeam 10,001

The associate will be responsible for processing professional claim forms files, reviewing policies and benefits, and ensuring compliance with HIPAA and confidentiality regulations. Key duties include researching, reviewing, prioritizing, and adjudicating claims according to defined workflows and meeting strict productivity and quality targets.

United States
NTT DATA logo

Claims Examiner Remote -Temporary

NTT DATA

NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. Our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in R&D.

Claims Specialist15 days ago
Full TimeRemoteTeam 10,001

The associate will be responsible for processing professional claim forms files, reviewing policies and benefits, and ensuring compliance with HIPAA and confidentiality regulations. Key duties include researching, reviewing, prioritizing, and adjudicating claims according to defined workflows and meeting strict productivity and quality targets.

United States