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.
About the role
- Claims Examiner for Sedgwick adjudicating complex workers' compensation claims within service expectations. Join a company recognized for its caring culture and work-life balance.
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
- 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
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
Benefits
- medical
- dental
- vision
- 401k and matching
- PTO
- disability and life insurance
- employee assistance
- flexible spending or health savings account
- other additional voluntary benefits
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