Claims Examiner I - Liability

Boca Raton, FL

Sedgwick Claims Management Services

Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and 'Claim Your Future.'

PRIMARY PURPOSE:; To analyze reported lower-level general liability claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

1. Adjusts claims under close supervision.

2. Handles lower-level liability and/or physical damage claims under close supervision.

3. Supports other claims examiners and claims supervisors with larger or more complex claims as necessary.

4. Processes general liability claims by gathering information to determine liability exposure, assigns reserve values to claims, making claims payments as necessary and settling claims up to the designated authority level.

5. Communicates claim action/processing with claimant, client, and appropriate medical contact.

6. Ensures claim files are properly documented and claims coding is correct.

7. Maintains professional client relationships.;

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

1. Performs other duties as assigned.

2. Supports the total performance management initiative.

QUALIFICATIONS

Education & Licensing
High school diploma or GED required.; Licenses as required.

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Experience
One (1) year of general office experience required.; Claims industry experience preferred.; Any college degree; may be substituted for the required experience.

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Skills & Knowledge

• Excellent oral and written communication

• PC literate, including Microsoft Office products

• Analytical and interpretive skills;

• Strong organizational skills;

• Good interpersonal skills;

• Ability to work in a team environment;

• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.;

Mental:; Clear and conceptual thinking ability; excellent judgment 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

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NOTE:; Credit security clearance, confirmed via a background credit check, is required for this position.

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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.

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