Senior Liability Claims Examiner
| Company | Sedgwick Claims Management Services |
|---|---|
| Location | Concord, CA, USA, Long Beach, CA, USA, Brea, CA, USA, Riverside, CA, USA, Roseville, CA, USA, San Diego, CA, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | Bachelor’s, JD |
| Experience Level | Senior |
Requirements
- Bachelor’s degree from an accredited college or university preferred
- Juris Doctorate (JD) preferred
- Ten (10) years of experience handling litigation including 5 years of claims management experience or equivalent combination of education and experience required
- 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
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
- Performs other duties as assigned
- Supports the organization’s quality program(s)
Preferred Qualifications
- Bachelor’s degree from an accredited college or university preferred
- Juris Doctorate (JD) preferred