at Sedgwick in Springfield, Illinois, United States
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.
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Claims Examiner – Multi-Line (Property/Casualty)
Public entity and/or commercial property claims handling experience a plus! Examples of claims files to be handled: General Liability, Police, Employment Liability, Auto Liability 3rd party, D&O and property claims.**
This is a desk claims examiner role, the position will be responsible for investigating, documenting, reviewing coverages, provisions, obtaining details, determining if there is coverage, setting reserves, submitting coverage analysis for review by the regional office, retaining counsel when necessary, entering payments, drafting denial letters, pursuing subrogation actions.
Are you looking for an impactful job where you can apply your knowledge and experience in the context of an energetic culture?
+ Enjoy flexibility and autonomy in your daily work, your location, and your career path.
+ Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
+ Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.
+ Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
ARE YOU AN IDEAL CANIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
PRIMARY PURPOSE : To analyze investigate, evaluate and adjust general liability/casualty/auto liability commercial and/or public entity claims.
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.
Education & Licensing
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.
Skills & Knowledge
+ 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
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.
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.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $70,000 to $75,000 USD/annual salary . A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
\#LI-REMOTE #LI-RS1 #claimsexaminer #claimsadjuster
*subject to change based on company needs
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you’re excited about this role but your experience doesn’t align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
Taking care of people is at the heart of everything we do. Caring counts
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivit