Claims Adjuster - Quebec Province, Canada - Sedgwick

Sedgwick

Verified Company

Quebec Province, Canada

2 weeks ago

Posted by:

Sophia Lee

beBee Recruiter

Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague.

A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve.

If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here.

Join us and contribute to Sedgwick being a great place to work.

Great Place to Work

Top 100 Most Loved Workplace

Forbes Best-in-State Employer

Claims Adjuster - Bodily Injury

PRIMARY PURPOSE:
To analyze mid
- and higher-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.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Manages midlevel 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.
Assesses liability and resolves claims within evaluation.
Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
Manages 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 complex 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

Four (4) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

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

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.

OBJECTIF PRINCIPAL :

Analyser les réclamations de niveau intermédiaire et supérieur en matière de responsabilité civile générale afin de déterminer les prestations à payer; assurer le règlement continu des réclamations dans le respect des normes de l'entreprise et des meilleures pratiques du secteur; savoir reconnaître les cas de subrogation et négocier des règlements pour ces réclamations.

FONCTIONS ESSENTIELLES et RESPONSABILITÉS

Gérer les réclamations de niveau intermédiaire en matière de responsabilité civile générale en recueillant des informations pour déterminer l'exposition à la responsabilité, attribuer des valeurs de provision aux réclamations, effectuer des paiements au besoin et régler les réclamations selon le niveau d'autorité désigné.

- Évaluer la responsabilité et régler les réclamations dans les paramètres de l'évaluation.

Approuver et traiter les réclamations attribuées, déterminer les prestations à payer et gérer le plan d'action conformément à la réclamation ou au contrat du client.
Gérer la subrogation des réclamations et négocier les règlements.
Communiquer les mesures prises au requérant et au client.
Veiller à ce que les dossiers de réclamation soient correctement documentés et à ce que les codes de réclamation soient corrects.
Le cas échéant, traiter les réclamations complexes de remboursement de frais médicaux à vie et/ou de frais médicaux à période déterminée, ce q