Talent.com
Claims Examiner | General Liability BI | Captive | Remote
Claims Examiner | General Liability BI | Captive | RemoteSedgwick • Providence, RI, US
Claims Examiner | General Liability BI | Captive | Remote

Claims Examiner | General Liability BI | Captive | Remote

Sedgwick • Providence, RI, US
[job_card.30_days_ago]
[job_preview.job_type]
  • [job_card.full_time]
  • [filters.remote]
[job_card.job_description]

Claims Examiner | General Liability BI | Captive | Remote

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies

Certified as a Great Place to Work

As a Claims Examiner at Sedgwick, you'll have the opportunity to take on new challenges and help solve complex problems.

  • Enjoy flexibility and autonomy in your daily work and your career path. This is a remote, work-at-home, telecommuter position.
  • Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.

Are you an ideal candidate? Do you have experience as a Bodily Injury General Liability Claims Examiner working within commercial (captive) insurance program(s)? Are you skilled in coverage determination, handling litigated claims, and interpreting endorsements, nature of loss, and excluded coverages? If so, and you're looking to join one of the premier teams in the industry, we're looking for someone with your level of expertise.

Primary Purpose : To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

Essential Functions and Responsibilities :

  • Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
  • Assesses liability and resolves claims within evaluation.
  • Negotiates settlement of claims within designated authority.
  • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
  • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
  • Prepares necessary state filings within statutory limits.
  • Manages the litigation process; ensures timely and cost effective claims resolution.
  • Coordinates vendor referrals for additional investigation and / or litigation management.
  • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
  • Manages claim recoveries, including but not limited to : subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
  • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
  • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
  • Ensures claim files are properly documented and claims coding is correct.
  • Refers cases as appropriate to supervisor and management.
  • 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. Professional certification as applicable to line of business preferred.

    Experience : Five (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.
  • Excellent oral and written communication, including presentation skills
  • PC literate, including Microsoft Office products
  • Analytical and interpretive skills
  • Strong organizational skills
  • Good interpersonal skills
  • Excellent negotiation skills
  • Ability to work in a team environment
  • Ability to meet or exceed Service Expectations
  • 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

    The range of starting pay for this role is $85,000.00 - $100,000.00 annual salary. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

    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.

    [job_alerts.create_a_job]

    Claim Examiner • Providence, RI, US

    [internal_linking.related_jobs]
    Claims Examiner | Auto BI, UM, LIS | Remote

    Claims Examiner | Auto BI, UM, LIS | Remote

    Rhode Island Staffing • Providence, RI, US
    [filters.remote]
    [job_card.full_time]
    Claims Examiner | Auto BI, UM, LIS | Remote.By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are facing...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Claims Team Lead - General Liability | Remote

    Claims Team Lead - General Liability | Remote

    Remote Staffing • Providence, RI, US
    [filters.remote]
    [job_card.full_time]
    Claims Team Lead - General Liability | Remote.By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are faci...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Senior Environmental Claims Adjuster (CONTRACT)

    Senior Environmental Claims Adjuster (CONTRACT)

    Argonaut Management Services, Inc • Providence, RI, United States
    [job_card.full_time]
    Argo Group International Holdings, Inc.American National, US based specialty P&C companies, (together known as BP&C, Inc. Brookfield Wealth Solutions, Ltd.BWS"), a New York and Toronto-listed public...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Remote Claims Writer

    Remote Claims Writer

    Metro Public Adjustment • Pawtucket, RI, US
    [filters.remote]
    [job_card.full_time]
    Job Description : The position we are hiring for is customer / client relations.In this position you will be writing claims and submitting the paperwork. Duties can be performed remotely.Company Inform...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Remote Entry-Level Currency Trader

    Remote Entry-Level Currency Trader

    Maverick Currencies • Providence, RI
    [filters.remote]
    [job_card.full_time] +1
    Top-ranked proprietary trading firm, Maverick Currencies, is searching for entrepreneurially-minded, profit-driven people to be trained in the art and science of proprietary trading in its online c...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Flexible Remote Work – Get Paid to Share Your Opinions on Top Brands

    Flexible Remote Work – Get Paid to Share Your Opinions on Top Brands

    OCPA • Sharon, Massachusetts, us
    [filters.remote]
    [job_card.part_time] +1
    Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies. We guarantee 15-25 hours per week with an hourly pay of bet...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Remote Content QA Reviewer

    Remote Content QA Reviewer

    Outlier • Pawtucket, RI, United States
    [filters.remote]
    [job_card.full_time]
    Earn up to $15 / hour + performance bonuses.Outlier, a platform owned and operated by Scale AI, is looking for.If you're passionate about improving models and excited by the future of AI, this is you...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Remote Product Tester - $25-45 per hour

    Remote Product Tester - $25-45 per hour

    Online Consumer Panels America • Pawtucket, Rhode Island, US
    [filters.remote]
    [job_card.part_time] +1
    Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies. We guarantee 15-25 hours per week with an hourly pay of bet...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Claims Examiner | Auto NF, PIP, MP | Remote

    Claims Examiner | Auto NF, PIP, MP | Remote

    Sedgwick • Providence, RI, US
    [filters.remote]
    [job_card.full_time]
    Claims Examiner | Auto NF, PIP, MP | Remote.By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are facing...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Travel Nurse - RN - ICU - Intensive Care Unit - $2375 / Week - Hiring Now

    Travel Nurse - RN - ICU - Intensive Care Unit - $2375 / Week - Hiring Now

    Cynet Health • Newport, RI, US
    [job_card.full_time]
    Cynet Health is seeking an experienced Intensive Care Unit Registered Nurse for an exciting Travel Nursing job in Newport, RI. Shift : 3x12 hr nights Start Date : 12 / 22 / 2025 Duration : 13 weeks Pay : $2...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Insurance Claims Environmental

    Insurance Claims Environmental

    Diedre Moire Corp. • Newport, RI, US
    [job_card.full_time]
    Claims Examiner Environmental - Newport, RI Insurance Claims Specialist Adjuster Examiner Analyst Attorney Environmental Toxic Tort Asbestos Pollution Health Hazard _. REMOTE WORK FROM HOME AVAILABL...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Claims Examiner | Auto NF, PIP, MP | Remote

    Claims Examiner | Auto NF, PIP, MP | Remote

    Remote Staffing • Providence, RI, US
    [filters.remote]
    [job_card.full_time]
    Claims Examiner | Auto NF, PIP, MP | Remote.By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are facing...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Senior Environmental Technical Claims Specialist

    Senior Environmental Technical Claims Specialist

    Argonaut Management Services, Inc • Providence, RI, United States
    [job_card.full_time]
    Argo Group International Holdings, Inc.American National, US based specialty P&C companies, (together known as BP&C, Inc. Brookfield Wealth Solutions, Ltd.BWS"), a New York and Toronto-listed public...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Remote Financial Advising Expert - AI Trainer ($50-$60 / hour)

    Remote Financial Advising Expert - AI Trainer ($50-$60 / hour)

    Data Annotation • Attleboro, Massachusetts
    [filters.remote]
    [job_card.full_time] +1
    We are looking for a finance professional to join our team to train AI models.You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of ...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Remote Survey Opinion Leader (Hiring Immediately)

    Remote Survey Opinion Leader (Hiring Immediately)

    Maxion Research • Norfolk, Massachusetts, US
    [filters.remote]
    [job_card.part_time]
    Join Our Part-Time Research Studies Today!.Are you eager to earn extra income from the comfort of your home? We are looking for motivated individuals to participate in paid research studies includi...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Travel MRI Tech - $2,620 to $2,928 per week in Newport, RI

    Travel MRI Tech - $2,620 to $2,928 per week in Newport, RI

    AlliedTravelCareers • Newport, RI, US
    [job_card.full_time]
    AlliedTravelCareers is working with Prime Time Healthcare to find a qualified MRI Tech in Newport, Rhode Island, 02840!.Now Hiring : Allied Healthcare MRI - Newport, RI. Contact us for Pay Informatio...[show_more]
    [last_updated.last_updated_variable_days] • [promoted]
    Remote Work – Product Assessments - $25-$45 per hour (No Experience)

    Remote Work – Product Assessments - $25-$45 per hour (No Experience)

    Online Consumer Panels America • Pawtucket, Rhode Island, US
    [filters.remote]
    [job_card.part_time] +1
    Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies. We guarantee 15-25 hours per week with an hourly pay of bet...[show_more]
    [last_updated.last_updated_30] • [promoted]
    Insurance Agent (Base salary + Uncapped commissions)

    Insurance Agent (Base salary + Uncapped commissions)

    Comparion Insurance Agency • Newport, Rhode Island, United States
    [job_card.full_time]
    Schedule : Full-Time Salary Range : USD $55000.Job Category : Sales - Comparion The typical starting salary range for this role is determined by a number of factors including skills, experience, educa...[show_more]
    [last_updated.last_updated_1_day] • [promoted]