Claims Representative, Recovery

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Claims Representative, Recovery

PRIMARY PURPOSE OF THE ROLE: Analyzes and processes complex claims, works with high exposure claims involving litigation, and ensures ongoing claims within service expectations, industry best practices and specific client service requirements. Identifies and pursues potential third-party subrogation recoveries associated with highest exposure/complexity claims, all lines of business across all jurisdictions.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• Reviews high exposure, complex multi-jurisdictional claims to establish potential for third party subrogation recovery by investigating and gathering information based on feasibility of recovery analysis and employment of strategies to manage the claim through timely resolution.

• Provides subrogation guidance and direction to both internal and external stakeholders to maximize recovery efforts in alignment with client, financial and jurisdictional strategy, and guidelines.

• Develops and pursues third party subrogation, refers assignments to subrogation counsel as dictated by statute or timeline, and discusses any compromised or negotiation of the claimed subrogation interest.

• Sends appropriate subrogation lien notifications to appropriate parties.

• Gathers information necessary to support viable subrogation claims; documents claim notes with appropriate information.

• Provides direction to assigned subrogation counsel.

• Maintains a diary on active claims with subrogation potential and claims that meet excess reporting criteria; ensures claim files are properly documented and claims coding is correct.

• Approves and makes timely claim payments relative to subrogation and settles complex/high exposure claims within designated client authority level.

• Manages claim recoveries, including but not limited to subrogation; secures recovery from responsible parties; enters recovery fees into claims management system.

• Prepares status reports for clients as required and presents in claims reviews.

• Provides additional layer subrogation expertise to peers and participates in team preparation for client reviews.

• Manages the litigation process; ensures timely and cost-effective resolution.

• Coordinates vendor referrals for additional investigation and/or litigation management.

• Develops training material and leads department training opportunities.

• Uses appropriate cost containment techniques, including strategic vendor partnerships, to reduce overall cost of claims for our clients.

• Assists in gathering important compliance/claims processing information to be presented at team meetings.

QUALIFICATIONS

• Education & Experience: Six (6) years of multi-jurisdictional liability (general liability, auto liability, products), subrogation and/or workers compensation claims handling experience or equivalent combination of education and experience required.

• Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.

• Excellent oral and written communication, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Good interpersonal skills

• Ability to work in a team environment

• Ability to meet or exceed Service Expectations

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.

When applicable and appropriate, consideration will be given to reasonable accommodations.

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.

at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Sedgwick is the worlds leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The companys expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com