Consumer Claims Examiner

**Must have Bodily Injury claims handling experience**
 
COMPLETE DESCRIPTION:
 
Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick has a strong commitment to its colleagues and its clients. If you are seeking a place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick is the place for you. As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as the Best TPA in America and the coveted Employer of Choice designation, we invite you to come be a part of our team and, "Claim Your Future."
 
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.
 
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
 
·         Analyzes and manages first 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.
 
ADDITIONAL FUNCTIONS AND RESPONSIBILITIES:
 
·         Performs other duties as assigned.
·         Supports the organization's quality program(s).
 
QUALIFICATIONS:
 
Education & Licensing:
 
·         Bachelor's degree from and accredited college or university preferred. Professional certification as applicable to line of business preferred. Licenses as required.
 
Experience:
 
·         Four (4) years of claims management experience or equivalent combination of experience and education required.
 
Skills & Knowledge:
 
·         In-depth knowledge of first party property and casualty claim 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
 
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.
 
Thanks and Regards,
Ali Khan
APN Software Services, Inc.
39899 Balentine Drive, Suite 385, Newark, CA 94560 
Direct: 510.870.8798 | Fax: 510.623.5055 | ali@apninc.com

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