Claims Expert/Adjuster

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.

Claims Expert/Adjuster

Claims Expert PRIMARY PURPOSE The claims expert is responsible for investigating, evaluating, and quantifying insurance claims. The claims expert must determine and provide recommendations regarding coverage, liability, and the amount to be paid, according to the policy terms.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Manage and process assigned claims while adhering to the company's quality standards, including conducting thorough investigations, determining coverage and the validity of claims, interviewing and communicating with insured parties, claimants, and witnesses, inspecting affected sites as needed, calling upon external vendors as required, formulating recommendations regarding provisions, preparing reports, and negotiating settlements within the granted authority. Participate in mediations and arbitrations as needed. Collaborate with defense attorneys as required.
• Maintain accurate records in compliance with the company's standards and procedures, using the company's specialized computer systems. Ability to work in external client systems.
• Precisely and efficiently manage the billing for assigned files, according to established schedules.
• Assist in the collection of accounts receivable for assigned claims.
• Participate in the local marketing efforts of the branch, attend professional and social events, and develop new business opportunities.
• Maintain excellent working relationships with existing clients to further develop business and participate, as required, in client file reviews and audits.
• Demonstrate a high level of mathematical reasoning and competence to calculate and analyze data and arrive at a logical conclusion.
• Be able to cope with extreme weather, environmental, and driving conditions at any time of day or night.
• Commit to continuous education to stay up-to-date with industry and legislative issues, changes, and licensing requirements.
• Ensure that provisions, coding, and reporting are up-to-date for assigned claims files.
• ADDITIONAL FUNCTIONS and RESPONSIBILITIES
• Perform other assigned functions.
• Support the organization's quality program(s).

Education & Licensing

• Post-secondary education.
• Hold or be working toward a PAA designation.
• Licensed or have the ability to obtain a provisional license.
• Valid driver's license.
• Proven claims expertise and negotiating skills.
• Excellent interpersonal and communication skills, and computer proficiency.

Experience

• Proven claims expertise and negotiating skills.
• Excellent interpersonal and communication skills, and computer proficiency.

Skills & Knowledge

• Strong knowledge of insurance, claims, or business management.
• Excellent oral and written communication.
• PC literate, including Microsoft Office products and Excel.
• Ability to navigate and work in client-required ancillary systems.
• Ability to work in a remote/home office environment.
• Analytical and interpretive skills.
• Strong organizational skills.
• Excellent interpersonal skills.
• Excellent negotiation skills.
• Ability to work in a team environment.
• Ability to meet or exceed expected performance levels.

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 position. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or change the duties of the position at any time.

We are committed to inclusive, barrier-free recruitment and selection processes. If contacted for an employment opportunity, please advise Colleague Resources if you require accommodation.

Adjuster PRIMARY PURPOSE A claims adjuster is charged with the investigation, evaluation, and quantification of an insurance claim. The adjuster will determine and provide recommendations with respect to coverage, liability, and quantum, within the terms of the policy.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Manages/Adjusts assigned claims while meeting company standards and quality, including conducting thorough investigations; determining coverage and validity of claims, interviewing and communicating with insured, claimants, and witnesses; inspecting claims sites as required, assigning external vendors as required, recommendations for reserves, preparing reports, and negotiating settlements within granted authority. Participate in mediation and arbitrations as required. Work with defense counsel as assigned.
• Maintains accurate records based on company standards and procedures, using company custom computer systems. Will require the ability to work in external client systems.
• Accurately and efficiently manages the billing for assigned files, within specified timelines.
• Assists with collection of accounts receivables for assigned claims.
• Assists with local marketing of the branch; attends professional and social events and develops new business opportunities.
• Maintains an excellent working relationship with existing clients to further develop business and will participate as required in client file reviews and audits.
• Requires a high level of mathematical and reasoning ability to calculate and analyze data to arrive at a logical conclusion.
• The ability to cope with extreme weather, environmental, and driving conditions at any time of day or night.
• Committed to continuous education to keep up-to-date with all industry and legislative issues and changes and licensing requirements.
• Responsible to ensure reserves, coding, and reporting is up-to-date on claims files assigned.
• Assists with local marketing of the branch; attends professional and social events and develops new business opportunities.
• ADDITIONAL FUNCTIONS and RESPONSIBILITIES
• Performs other duties as assigned.
• Supports the organization's quality program(s).

Education & Licensing

• Post-secondary education.
• Has or is working toward CIP designation.
• Must be licensed or have the ability to obtain a provisional license.
• Must possess a valid driver's license.
• Proven adjusting and negotiating skills.
• Excellent interpersonal and communication skills, and computer proficiency.

Experience

• Proven adjusting and negotiating skills.
• Excellent interpersonal and communication skills, and computer proficiency.

Skills & Knowledge

• Strong knowledge of insurance, claims, or business management.
• Excellent oral and written communication.
• PC literate, including Microsoft Office products and Excel.
• Ability to navigate and work in client-required ancillary systems.
• Ability to work in a remote/home office environment.
• Analytical and interpretive skills.
• Strong organizational skills.
• Excellent interpersonal skills.
• Excellent negotiation skills.
• Ability to work in a team environment.
• Ability to meet or exceed Performance Competencies.

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.

We are committed to inclusive, barrier-free recruitment and selection processes. If contacted for an employment opportunity, please advise Colleague Resources if you require accommodation.