Claims Adjuster I, PD Experience

🔥 44 minutes ago

🇺🇸 United States – Remote

💵 $63.4k - $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Sedgwick

WebsiteLinkedInAll Job Openings

10,000+ employees

🏗️ Construction

💼 Consulting

🏥 Healthcare

Construction • Consulting • Healthcare

Sedgwick is a global provider of technology-enabled risk, benefits, and integrated business solutions. They help people and organizations by managing and mitigating risk with solutions in accident, health, disability, unemployment compensation, and liability claims administration, among others. Sedgwick offers services such as claims administration, building consulting, forensic accounting, and forensic engineering. Their specialties include property restoration, brand protection, and loss prevention across several industries, including agriculture, construction, and environmental sectors. The company emphasizes diversity, equity, and inclusion (DEI) as well as environmental, social, and governance (ESG) practices.

📋 Description

• Analyze mid- and higher-level general liability claims to determine benefits due • Ensure ongoing adjudication of claims within company standards and industry best practices • Identify subrogation opportunities and negotiate settlements • Gather information to determine liability exposure • Assign reserve values and make claims payments as necessary • Settle claims up to the designated authority level • Assess liability and resolve claims within evaluation • Approve and process assigned claims and determine benefits due • Manage action plans pursuant to the claim or client contract • Communicate claim actions with claimants and clients • Ensure claim files are properly documented and claims coding is correct • Process complex lifetime medical and/or defined period medical claims when applicable • Maintain professional client relationships • Support the organization's quality programs • Perform other duties as assigned • Travel as required

🎯 Requirements

• Four (4) years of claims management experience or equivalent combination of education and experience required • Bachelor's degree from an accredited college or university preferred • Subject matter expertise in appropriate insurance principles and laws for the applicable line of business • Knowledge of recoveries, offsets and deductions, claim and disability duration, cost containment principles, medical management practices, and Social Security and Medicare application procedures as applicable • Excellent oral and written communication, including presentation skills • PC literacy, 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 • Ability to handle multiple priorities simultaneously and meet deadlines • Ability to travel as required

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • 401(k) and matching • PTO • Disability insurance • Life insurance • Employee assistance • Flexible spending or health savings account • Other additional voluntary benefits • Reasonable accommodations when applicable and appropriate

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