Claims Examiner | General Liability BI | Captive | Remote

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This a Full Remote job, the offer is available from: United States

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Claims Examiner | General Liability BI | Captive | Remote

As a Claims Examiner at Sedgwick, you’ll have the opportunity to take on new challenges and help solve complex problems.

  • Enjoy flexibility and autonomy in your daily work and your career path. This is a remote, work-at-home, telecommuter position.

  • Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. 

ARE YOU AN IDEAL CANDIDATE? Do you have experience as a Bodily Injury General Liability Claims Examiner working within commercial (captive) insurance program(s)? Are you skilled in coverage determination, handling litigated claims, and interpreting endorsements, nature of loss, and excluded coverages? If so, and you're looking to join one of the premier teams in the industry, we’re looking for someone with your level of expertise.

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.

QUALIFICATIONS

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

  • 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

WORK ENVIRONMENT
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

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 $85,000.00 - $100,000.00 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. Always accepting applications.

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.

#LI-REMOTE #claimsexaminer

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.

This offer from "Sedgwick" has been enriched by Jobgether.com and got a 72% flex score.
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Top 25 Common Interview Questions and Answers

To get a job means you must be ready for an interview. Most people get confused about how they should face an interview to impress the employer. The fact cannot be ignored that landing an interview is no less than a huge achievement as we know how competitive today’s world is. Clearing an interview means you would be securing the job. It does not matter if you are a fresh graduate, are supposed to transition your career, or believe to have a higher position, preparing for an interview is important indeed.

Here, we are going to share the top 25 highly common interview questions along with tips as well as sample answers to help you stand out from others in today’s highly competitive job market in the USA.

1. Give me your introduction in short.

This is the most common questions asked by every interviewer. The fact cannot be ignored that it irritates sometimes as well. But the fact cannot be ignored that it is important as well to fetch important information about an employee.
“Myself ....(your name)…. and I hold a degree in ……….(your field name)……… from…..(university name)... .over….(duration of your). I hold experience in ….(respective field)... .specialized in ….(share your genre)... .Currently, I am working on a project and received positive reviews from the employer.

2. Describe your excellent achievement in your job career.

My greatest achievement was leading a team to do a prominent project within a stipulated time and budget. And that project set our company different from its competitors among our clients.

3. What are the reasons to work with us?

Upon asking this question, you should emphasize that you are aware of the company’s profile and adhere to align your values with theirs. I have always admired this company because of its sustainability and innovation factors. I will keep working with you and contribute to taking it to the next level.

4. Reasons to quit your last job.

The reason to quit my last job is to seek more new challenges and opportunities for growth. I want to hone my skills in a new environment. I believe in keeping going on with new challenges as I think that comfort zone eradicates your creativity.

5. What about your strengths?

Here, you need to be smart and relevant both at the same time. Problem Solving is one of my key strengths. I believe in focusing on the solution and can improve your efficiency by 20% by introducing strategic solutions.

6. What is your weakness?

I believe in doing every work with so much perfection and it takes me slow sometimes. However, I am trying to balance quality and efficiency by dividing my attention towards goals and deadlines.

7. Why should we hire you?

With my huge experience in …………. And holding a proven track record of delivering projects within time, I believe in my ability to cater to your team effectively. Moreover, I believe in giving the best to my work as it brings personal satisfaction to me.

8. In your previous company, what prominent challenges did you face, and how did you deal with them?

In my previous company job profile, we faced a sudden budget cut and delivered a project within the stipulated time with no huge team. I led my team and accomplished that project within that limited budget and time without compromising project quality. Accomplishing a project within a limited budget always makes me feel proud.

9. What is your ideal way to tackle stress and pressure?

I believe in being organized and prioritizing tasks. Once you know how much time you need to give to a particular task, it helps to cut down on high pressure. I believe in making a strategy to get the most out of it. I believe in being calm under pressure.

10. What is your way to prioritize your work?

I believe in going with the deadlines and significance of the project to keep myself productive and free from stress. Moreover, I keep working on a progress tracker to keep boosting my energy.

11. Things that motivate you.

Solving complex issues is what keeps me motivated and seeing the tangible results of my work. Moreover, dynamic as well as innovative environments always boost me up.

12. What is your way of handling criticism?

I always see criticism as a way to hone my skills and an opportunity to learn and grow. I always listen quite carefully and act accordingly to come up with satisfactory results.

13. Describe a time you worked in a team.

I collaborated with a diverse team in my last company to come up with a new marketing strategy. My role in that team was to integrate social media efforts resulting in 25% increased engagement.

14. What is your way of dealing with difficult coworkers?

I am a firm believer in addressing conflicts directly and professionally to come up with a solution. Open communication is my asset and understanding different perspectives to solve issues amicably.

15. Reasons to get this job?

This job sits well with my skills in this field as well as my passion for learning more about new things. I am excited to contribute and learn more in your company professionally.

16. How would you be handling multiple deadlines if given?

The simple thing from my perspective is to stay organized and divide the tasks into manageable steps. I believe in doing the work based on urgency and impact.

17. Tell us about the time you failed badly in your job.

Once I missed a significant deadline because of not being good at time management. This is how I learned about time management and being adhered to realistic goals to improve my planning skills in an ideal manner.

18. How do you see yourself outside of work?

I enjoy reading a lot related to my profession. Moreover, reading makes me calm too. Apart from that, hiking and roaming to peaceful places are my favorite things to do.

19. What are your salary expectations?

Following my research and the responsibilities of the role, I expect a salary in the range of $...... to $..... Though, I am open to knowing your side as well.

20. What do you expect from yourself in the next five years?

I am a keen learner and want to expand my knowledge by getting associated with your company. I want to take on more leadership responsibilities and contribute to achieving success in highly creative ways.

21. What do you think about the latest industry trends and changes?

I believe in keeping myself updated about the latest and ongoing industry trends and changes. I keep following the latest job profile e-newsletter; and also attend relevant webinars and conferences. Learning is a never-ending process.

22. How do you describe your ideal work environment?

For me an ideal work environment is all about having open communication and teamwork to achieve success, to learn more, and to have excellent professional growth.

23. How aware are you of our company?

I know this company has established itself as one of the prominent companies in today’s tech industry. It is known for its excellent solutions, creative ways, and commitment to sustainability. The current services and their success rate make this company completely different from others.

24. What skills can you add to this job?

I have been in this field for the past 5-6 years and hold huge experience identifying trends that lead to exceptional business growth. I am also good at communication and teamwork to make the most of it.

25. Do you have any questions for us?

Yes, I would like to know more about the team I would be working with. What sort of challenges are the team currently going through? What is about the career growth in this company?