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Claims Examiner, Auto | General Liability | Bodily Injury | New Jersey Claims Required
PRIMARY PURPOSE OF THE ROLE
To investigate, evaluate, negotiate, and resolve complex general liability claims while ensuring excellent service delivery to clients and claimants. This role manages high-exposure claims, including litigated matters, with a focus on timely resolution, cost containment, and compliance with client and regulatory requirements.
ESSENTIAL RESPONSIBILITIES MAY INCLUDE
- Analyze and manage complex or technically challenging general liability claims from inception through resolution.
- Conduct thorough investigations to determine liability, damages, and claim exposure.
- Develop and execute strategic claim action plans to drive timely and appropriate claim outcomes.
- Assess liability and negotiate settlements within assigned authority limits.
- Calculate, establish, and maintain appropriate claim reserves throughout the life of the claim.
- Authorize and process claim payments and adjustments within delegated authority.
- Ensure compliance with applicable laws, regulations, and client-specific requirements.
- Prepare and submit required state filings within statutory deadlines.
- Report claims to excess carriers and respond promptly to requests for information or direction.
- Manage litigated claims through effective collaboration with defense counsel and external partners.
- Coordinate vendor referrals for investigations, medical reviews, surveillance, and litigation management services.
- Utilize cost-containment strategies and strategic vendor partnerships to help reduce overall claim costs.
- Pursue and manage claim recoveries, including subrogation and applicable offsets.
- Maintain proactive communication with claimants, clients, attorneys, and other stakeholders.
- Build and maintain strong client relationships through professional and responsive service.
- Ensure claim files are accurately documented and coded in accordance with company standards.
- Escalate complex issues and high-exposure matters to leadership as appropriate.
- Perform other duties as assigned.
QUALIFICATIONS
Education & Experience: Five (5) years of claims handling experience, or an equivalent combination of education and relevant experience.
- Experience handling complex general liability claims preferred.
- Litigation management experience strongly preferred.
- Bachelor's degree from an accredited college or university preferred.
- Industry certifications relevant to the line of business are preferred.
SKILLS & KNOWLEDGE
- Strong knowledge of general liability claims practices, insurance principles, and applicable regulations.
- Understanding of recovery opportunities, subrogation, offsets, and cost containment strategies.
- Excellent verbal, written, and presentation communication skills.
- Strong analytical, investigative, and problem-solving abilities.
- Effective negotiation and settlement management skills.
- Ability to prioritize workload and manage multiple competing priorities.
- Demonstrated ability to work independently and collaboratively within a team environment.
- Proficiency with Microsoft Office applications and claims management systems.
- Commitment to delivering exceptional customer and client service.
Work environment requirements include –
Physical: Computer keyboarding
Auditory/visual: Hearing, vision and talking
Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $70,000 to $80,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
The statements contained in this description are intended to describe the general nature and level of work being performed. They are not intended to be an exhaustive list of all responsibilities, duties, or requirements. Management reserves the right to modify, add, or remove duties as business needs require.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.