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Claims Associate - Liability

Role overview

Summary

This role is for analyzing lower-level general liability claims at Sedgwick. It focuses on determining benefits due and ensuring claims are processed according to company standards. You will support other claims representatives and maintain professional relationships with clients.

Qualifications

  • High school diploma or GED.
  • One (1) year of general office experience or equivalent combination of education and experience.
  • Excellent oral and written communication skills.
  • PC literate, including Microsoft Office products.
  • Analytical and interpretive skills.

Responsibilities

  • Analyze reported lower-level general liability claims to determine benefits due.
  • Process general liability claims determining compensability and benefits due.
  • Communicate claim action/processing with claimant, client and appropriate medical contact.
  • Maintain professional client relationships.

Key facts

Hard skills

Other skills

  • Analytical Skills
  • Communication
  • Teamwork
  • Social Skills
  • Problem Solving

About the company

EFI Global logo

EFI Global

  • Engineering Services
  • SME
  • 501–1,000
Over the last four decades, we have grown from a boutique firm specializing in handling insurance fraud and arson cases and providing expert witness testimony, to becoming a recognized leader in engineering failure analysis, origin and cause investigations, environmental consulting, laboratory testing and specialty consulting. Each member of our multi-disciplinary team of more than 700 professional engineers, fire investigators, architects and scientists was selected for his or her technical proficiency, in-depth industry knowledge and commitment to professional integrity. Together, our diverse backgrounds and collective insights empower clients to make better-informed business decisions. This expertise, coupled with the extensive coverage of more than 62 national offices plus offices in Canada, the United Kingdom and Brazil to provide global work abroad capability, has earned us a reputation for delivering timely responses that consistently meets our clients’ expectations — anytime, anywhere. EFI Global currently provides engineering services in the state of North Carolina by our partner firm, EFI Global of North Carolina, P.C. We also provide engineering services in the states of New York and New Jersey by our partner firm, EFI Global Engineering of New York, P.C. EFI Global is part of the Sedgwick family of companies, a global leader in the independent insurance claims industry.

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Job description

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®

Fortune Best Workplaces in Financial Services & Insurance

Claims Associate - LiabilityPRIMARY PURPOSE: To analyze reported lower-level level general liability claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES• Handles lower-level liability and/or physical damage claims under close supervision.
• Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
• Processes general liability claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency.
• Communicates claim action/processing with claimant, client and appropriate medical contact.
• Ensures claim files are properly documented and claims coding is correct.
• May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.
• Maintains professional client relationships.ADDITIONAL FUNCTIONS and RESPONSIBILITIES• Performs other duties as assigned.
• Supports the organization's quality program(s).QUALIFICATIONEducation & Licensing
High school diploma or GED required. Licenses as required.
Experience
One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.Skills & Knowledge• Excellent oral and written communication 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 Performance CompetenciesWORK 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

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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.

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