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Sedgwick Claims Management Services
Cincinnati, Ohio, United States (on-site)
19 days ago

Description

The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.

Claims Examiner - Liability, Litigated Insurance Claims (REMOTE)

IF YOU CARE, THERE'S A PLACE FOR YOU HERE

For a career path that is both challenging and rewarding, join Sedgwick's talented team of 27,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets-their employees, their customers and their property. At Sedgwick, caring counts®. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.

With one of the largest teams of liability experts in the world, Sedgwick supports and resolves property, general, auto, product and professional liability claims. We help our clients maintain brand protection in times of crisis.

This role is open to a remote, telecommute, work-at-home setting.*

Insurance claims legal experience highly desired (claims in litigation).

PRIMARY PURPOSE : To address and handle high end cases with serious injuries, complex coverage scenarios and legal inquiries or disputes; to develop a strategy to bring a case to satisfactory resolution.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES
  • Reviews/acts on reports/forms; responds to inquiries; seeks legal opinion and early resolution; and communicates resolution to appropriate parties.
  • Handles high end cases with serious injuries and/or complex coverage scenarios.
  • Responds to decisions, agreement, and/or court order; creates action plan; determines need for examination; gains client authorization.
  • Identifies cases for settlements/redemptions.
  • Gathers/documents additional information and coordinates with client designees.
  • Requests legal/private investigation; assigns to and coordinates with local counsel; monitors local counsel performance.
  • Responds to plaintiff's counsel, union, employee, or client requests.
  • Identifies issues and formulates defense strategy.
  • Establishes/adjusts accrued liability and approves administrative expenses.
  • Identifies subrogation opportunities and manages process.
  • Attends and participates in mediations, trials, arbitrations or hearings as needed.
  • Works with partners to affect early return-to-work.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES
  • Performs other duties as assigned.
  • Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing
Bachelor's degree from an accredited college or university preferred. Juris Doctorate (JD) preferred.

Experience
Ten (10) years of experience handling litigation including 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.
  • Technically skilled and familiar with legal pleadings, discovery et al
  • Excellent oral and written communication, including presentation skills
  • PC literate, including Microsoft Office products
  • Analytical and interpretive skills
  • Strong organizational skills
  • Excellent interpersonal skills
  • Excellent negotiation 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, 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

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

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-KN1 #LI-REMOTE

*subject to change based on company need

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
Requisition #: R24008

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Job Information

  • Job ID: 65501639
  • Workplace Type: On-Site
  • Location:
    Cincinnati, Ohio, United States
  • Position Title: Claims Examiner - Liability, Litigated Insurance Claims (REMOTE)
  • Company Name For Job: Sedgwick Claims Management Services
  • Job Function: Claims
  • Job Type: Full-Time
Insurance
Tennessee , United States

Sedgwick Claims Management Services, Inc. (Sedgwick CMS) is the leader in innovative claims and productivity management solutions to major employers. Sedgwick CMS provides cost-effective claims administration, managed care, program management and related services through the expertise of 6,400 colleagues in more than one hundred and fifty offices and service locations in the U.S. and Canada.

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