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Claims Examiner - Liability Bodily Injury

Company: Sedgwick
Location: Virginia Beach
Posted on: September 18, 2022

Job 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.

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work -
Most Loved Workplace -
Forbes Best-in-State Employer

Claims Examiner - Liability Bodily Injury

***Remote from anywhere within the U.S. NY adjuster's license is preferred, but not required.***

PRIMARY PURPOSE: To analyze reports claims, determine benefits due and make timely payments and adjustments to complex program claims; to coordinate investigative efforts; to thoroughly review contested claims and negotiate settlement of claims up to the designated authority level; to assist with assignment of daily workflow; to assist with training and deployment of changes in client instructions; and to provide superior customer services.


  • Analyzes and manages third party property, casualty and/or medical reimbursement claims based on multiple/additional coverage and/or programs as defined by client-specific program.
  • Makes coverage determinations based on investigation/evaluation and communicates claim actions with claimant and client.
  • Adjudicates proper settlements up to designated authority level.
  • Works directly with underwriter/client on high value complex cases.
  • Handles high volume of claims, phone calls and correspondence ensuring claim files are properly documented; and meets quality/production goals and customer guidelines and deadlines.
  • Communicates claim activity process with client and claimant as appropriate.
  • Assists with assignment of daily workflow in the department and client data tracking system.
  • Assists with coaching, training and deployment of changes in client instructions.

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


      Education & Licensing
      Bachelor's degree from and accredited college or university preferred. Professional certification as applicable to line of business preferred. Licenses as required.

      Four (4) years of claims management experience or equivalent combination of experience and education required.

      Skills & Knowledge
      • In-depth knowledge of third party property, casualty, and/or medical reimbursement claims adjudication as applicable to line of business
      • Superior oral and written communication, including presentation skills
      • PC literate, including Microsoft Office products
      • Superior analytical and interpretive skills
      • Superior organizational skills
      • Superior interpersonal skills
      • Ability to work in a team environment
      • Ability to meet or exceed Performance Competencies

        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.

        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.

Keywords: Sedgwick, Virginia Beach , Claims Examiner - Liability Bodily Injury, Other , Virginia Beach, Virginia

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