Claims Examiner

4 days ago

Mississauga, Canada Sedgwick Full time

Claims Examiner - Liability

Caring starts with you

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work®

Most Loved Workplace®

Forbes Best-in-State Employer

PRIMARY PURPOSE: 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; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES- 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 clams 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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES- Performs other duties as assigned.- Supports the organization's quality program(s).- Travels as required.

QUALIFICATION

Education & Licensing

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

Experience

Five (5) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge-
- 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

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

We are committed to inclusive, barrier-free recruitment and selection processes. If contacted for an employment opportunity, please advise Colleague Resources if you require accommodation.

Sedgwick is an Equal Opportunity Employer.

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