Claims Representative - Liability (Remote)
Sedgwick
TN
há 5 dias

PRIMARY PURPOSE

  • To process low level general liability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices;
  • and to identify subrogation of claims and negotiate settlements with general supervision.

    ESSENTIAL FUNCTIONS and RESPONSIBILITIES

  • Processes low level 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 designated authority level.
  • Develops and coordinates low level general liability claims' action plans to resolution, return-to-work efforts, and approves claim payments.
  • Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
  • Administers subrogation of claims and negotiates settlements.
  • Communicates claim action with claimant and client.
  • Ensures claim files are properly documented and claims coding is correct.
  • May process low-level lifetime medical and / or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
  • Maintains professional client relationships.
  • ADDITIONAL FUNCTIONS and RESPONSIBILITIES

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

    Education & Licensing

    Bachelor's degree from an accredited college or university preferred.

    Experience

    Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.

    Skills & Knowledge

  • Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
  • Excellent oral and written communication, including presentation skills
  • 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 Service Expectations
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