Claims Adjuster handling commercial claims for an innovative insurance startup utilizing real - time data. Collaborating with a global team and driving successful claims outcomes in a high - growth environment.
About the role
- Claims Examiner adjudicating complex workers' compensation claims at Sedgwick. Analyzing claims, negotiating settlements, and managing resolutions for clients in various industries.
Responsibilities
- Analyzes and processes complex or technically difficult workers' compensation 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 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.
- Performs other duties as assigned.
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.
- Jurisdiction Knowledge: CA.
- Licensing: CA required and SIP preferred.
Benefits
- Flexible work schedule.
- Referral incentive program.
- Opportunity to work in an agile environment.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
Job title
Job type
Experience level
Salary
Degree requirement
Location requirements
Claims Adjuster managing mid - and higher - level general liability claims for a global industry leader. Assessing liability, negotiating settlements, and maintaining professional client relationships.
Claims Processor assessing and logging drug requests for Canada Life in a fast - paced environment. Requires strong time management and organizational skills with a focus on customer service.
Senior Complex Claims Specialist at Hiscox optimizing claims handling and strategies for Construction Defect and Property Damage. Collaborating with legal teams and ensuring effective claims resolution processes.
Senior level Complex Claims Specialist at Hiscox adjudicating General Liability claims. Focused on early settlements and litigation management with a commitment to superior customer service.
Field Claims Representative at Auto - Owners handling insurance claims throughout Iowa. Responsibilities include investigation, evaluation, and resolution of claims in the property and casualty segment.
Field Claims Adjuster managing claims and ensuring business development opportunities for ClaimsPro in a hybrid environment. Providing high - level customer service and adjusting claims in Lloydminster area.
Internal Property Claims Adjuster assisting customers with home insurance claims. Investigating and managing claims for personal and commercial lines within a supportive team environment.
Claims Adjuster II focusing on home insurance claims while supporting customers through complex situations. Join a hybrid team dedicated to helping people recover from unexpected events.
Analista de Sinistros RE Junior managing transport claims analysis for Tokio Marine, offering diverse employee benefits and opportunities.