Claims Examiner - Auto

Sedgwick - Houston, TX

Full-time - Mid Level

Houston, TX

10,001+ employees

Insurance Carriers and Related Activities

About the position

The Claims Examiner - Auto position at Sedgwick involves analyzing and processing complex auto and commercial transportation claims. The role focuses on reviewing coverage, conducting investigations, determining liability, and evaluating damages. The position is integral to ensuring claims are handled efficiently and effectively, contributing to the overall mission of providing excellent service to clients and insured parties.

Responsibilities

• Processes complex auto commercial and personal line claims, including bodily injury, ensuring claim files are properly documented and coded correctly.
• Responsible for litigation process on litigated claims.
• Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.
• Reports large claims to excess carrier(s).
• Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.
• Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.
• Communicates claim action/processing with insured, client, and agent or broker when appropriate.

Requirements

• Bachelor's degree from an accredited college or university preferred.
• Five (5) years of claims management experience or equivalent combination of education and experience required, including in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws.
• Professional certification as applicable to line of business preferred.
• Secure and maintain the State adjusting licenses as required for the position.

Nice-to-haves

• Knowledge of medical terminology for claim evaluation and Medicare compliance.
• Knowledge of appropriate application for deductibles, sub-limits, SIR's, carrier and large deductible programs.

Benefits

• Flexible work environment
• Support for mental, physical, financial, and professional needs
• Opportunities for career growth and skill sharpening
• Diversity and inclusion initiatives