Claims Examiner, Liability (Auto)

As a Claims Examiner, Liability (Auto) at Sedgwick, your main responsibilities include analyzing and processing complex auto and commercial transportation claims. This entails reviewing coverage, investigating claims, determining liability, and assessing damages. You'll also coordinate litigation on litigated claims, maintain action plans to meet state deadlines, and communicate effectively with insured parties, clients, and brokers when necessary.

To qualify for the Claims Examiner, Liability (Auto) role at Sedgwick, you typically need a Bachelor's degree from an accredited institution, along with relevant state adjusting licenses. Candidates should have at least five years of claims management experience or a combination of education and experience that provides in-depth knowledge of personal and commercial auto policies, laws, and principles.

Successful Claims Examiners at Sedgwick possess strong communication skills, both written and oral, along with excellent organizational and negotiation abilities. Knowledge of medical terminology for claims evaluation, familiarity with deductibles and sub-limits, and the ability to work effectively in a team are also important skills for this role.

The work environment for a Claims Examiner, Liability (Auto) at Sedgwick is inclusive and supportive, with a focus on mental and physical well-being. Employees may work from home or in an office setting, accommodating reasonable requests for flexibility. Sedgwick’s culture emphasizes teamwork, respect, and the importance of balancing work and personal life.

Sedgwick prioritizes the growth of its employees by offering continuous learning opportunities, professional certifications, and mentorship programs. The company encourages Claims Examiners, Liability (Auto) to enhance their expertise and skills through various training resources, ensuring that they stay current with industry trends and best practices.

In your response, provide specific examples of situations where you've successfully analyzed claims. Highlight how you reviewed coverage details, determined liability, and resolved disputes. Demonstrating your attention to detail and understanding of auto insurance policies will show your suitability for the Claims Examiner role.

When faced with multiple claims, I prioritize based on urgency and compliance deadlines. I assess each claim's complexity and potential impact on clients. Effective time management and the use of organizational tools help me ensure deadlines are met while maintaining high quality in my work.

Effective communication starts with active listening to understand the concerns of clients and insured parties. I aim to communicate clearly and empathetically, ensuring that complex information is conveyed in a manner that is easily understood. Building trust is essential, and I follow up regularly to keep them informed.

Choose an example that illustrates your problem-solving skills and ability to navigate complexities in claims management. Discuss the steps you took to analyze the claim, any negotiations that took place, and how you ultimately reached a resolution that satisfied all parties involved.

I stay informed by regularly reading industry publications, attending webinars, and participating in professional associations. Networking with other professionals in the field also helps me exchange insights and ensure compliance with any new laws and regulations impacting claims management.

When discussing my experience with subrogation, I share specific instances where I've identified opportunities for risk transfer, demonstrating how I secured recoveries for the organization. This highlights my understanding of the claims process and the importance of a proactive approach.

In handling disputes over liability, I focus on thorough documentation and clear evidence to support my position. I aim for open conversations with all parties involved to negotiate effectively, ensuring that our findings are communicated transparently to facilitate a resolution amicably.

I utilize checklists and templates to ensure comprehensive coverage of all aspects of the claim. Regular audits of claim files also help maintain accuracy and consistency. Ensuring documentation is clear and thorough fosters trust and expedites the claims process.

Demonstrating knowledge of medical terminology is crucial in claims evaluation. I articulate how understanding medical terms helps in assessing bodily injury claims accurately, ensuring compliance with Medicare regulations and facilitating better communication with medical professionals involved in the claims process.

When I suspect a claim may be fraudulent, I conduct a thorough investigation to gather all relevant facts, following established protocols for reporting potential fraud. Collaboration with internal and external resources is key to ensuring that every angle is explored to confirm the claim's legitimacy before making a decision.