Commercial General Liability Adjuster/ Expert(e) en sinistres - Responsabilité civile job opportunity at Sedgwick.

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Sedgwick Commercial General Liability Adjuster/ Expert(e) en sinistres - Responsabilité civile
Experience: General
Pattern: full-time
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By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Commercial General Liability Adjuster/ Expert(e) en sinistres - Responsabilité civile 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 mid-level 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 or college diploma preferred.    Experience   Four (4) years of claims management experience or equivalent combination of education and experience required .      Skills & Knowledge   Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles   Excellent oral and written communication   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     Job type: We are currently hiring for this position   Compensation Information: Salary Range : $55,000 - $75,000 annually Compensation is determined based on experience, qualifications, and internal equity. Sedgwick is committed to transparent and equitable pay practices. 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. Where applicable, Sedgwick uses artificial intelligence tools to assist in the screening, assessment, or selection of candidates. These tools are subject to periodic review. 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. Sedgwick is an Equal Opportunity Employer 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 qui comprend les déclarations provinciales et du médecin ainsi que les décisions quant aux traitements appropriés recommandés par l’examen de l’utilisation.   Maintenir des relations professionnelles avec les clients.     AUTRES FONCTIONS et RESPONSABILITÉS   S’acquitter d’autres fonctions attribuées.   Prendre en charge le(s) programme(s) de qualité de l’organisation.   Voyager vers d’autres régions selon les besoins.     QUALIFICATIONS   Formation et accréditations   Préférence pour les titulaires d’un baccalauréat ou d’un diplôme de niveau collégial.    Expérience   Quatre (4) années d’expérience en gestion des réclamations, ou combinaison équivalente d’études et d’expérience requis.      Compétences et connaissances   Expertise relative aux principes d’assurance et aux lois appropriés pour le secteur d’activité, aux compensations et retenues de recouvrement, à la durée des réclamations et des prestations d’invalidité et aux principes de contrôle des coûts.   Excellente communication orale et écrite   Connaissances informatiques, y compris les produits Microsoft Office   Compétences d’analyse et d’interprétation   Solides compétences organisationnelles   Bonnes aptitudes interpersonnelles   Excellentes aptitudes à la négociation   Capacité à travailler efficacement dans un environnement d’équipe   Capacité à atteindre ou dépasser le niveau de service attendu     Les déclarations contenues dans ce document sont destinées à décrire la nature générale et le niveau du travail effectué par un(e) collègue affecté(e) à ce poste. Elles ne constituent pas une liste exhaustive de fonctions, de devoirs ou de variantes locales. La direction se réserve le droit d’ajouter ou de modifier à sa discrétion les fonctions du poste en tout temps.     Nous nous sommes engagés à mettre en place des processus de recrutement et de sélection inclusifs et sans obstacle. Si l’on vous contacte pour une offre d’emploi, veuillez communiquer avec les Ressources collègues si vous avez besoin de mesures d’adaptation.     Sedgwick est un employeur soucieux de l’égalité des chances   Sedgwick is an Equal Opportunity Employer. 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. Sedgwick retains the discretion to add or to change the duties of the position at any time.

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