• Review, evaluate, and process various Stop Loss claims in accordance with established standards • Build positive client relationships and provide education • Analyze client claim losses and current issues • Follow up on pended claims as per department standards • Process daily incoming Stop Loss claims • Evaluate claims for compliance with policy provisions and regulatory guidelines • Monitor and analyze complex claims and control losses through managed care • Finalize and adjudicate claims up to a pre-determined dollar threshold • Complete pended claim letters to TPAs or brokers • Identify discrepancies in claims submissions

Overview Be the bridge between coverage and care As an Insurance Claims Support Specialist, you play a critical role in ensuring claims are processed accurately, efficiently, and in compliance with regulatory standards. You’ll investigate and evaluate claims, verify coverage, and support timely resolution while collaborating with internal teams and external stakeholders. This role involves responding to inquiries, assisting clients with proper claim submission, and maintaining detailed, compliant records. Your work helps drive operational efficiency, supports audit readiness, and ensures a seamless claims experience for all parties involved. Responsibilities Key Responsibilities • Review and evaluate insurance claims to ensure accuracy and timely processing• Investigate claims, gather relevant information, and support settlement negotiations• Respond to inquiries from claimants, providers, and other related parties• Assist clients in submitting claims accurately and in accordance with guidelines• Collaborate with internal teams to facilitate efficient claim resolution• Maintain detailed, accurate records and ensure compliance with regulatory and audit requirements Qualifications Minimum Qualifications Required: • High school diploma or equivalent• 2+ years of experience in insurance coverages or related support• Working knowledge of insurance policies, coverage, and claim adjudication processes• Experience investigating, resolving, and following up on claim issues• Strong communication and customer service skills with the ability to manage high-volume phone work• Ability to maintain accurate records and ensure compliance with regulatory requirements Preferred: • Experience with Epic• Insurance registration experience• Medical/healthcare experience• Willingness to handle a high volume of outbound calls

• Reporting to the National Manager • Providing a consistently high level of service • Investigating insurance claims • Negotiating settlement of the claims • Managing comprehensive desktop investigation of assigned claims • Maintaining accurate records based on company standards and procedures • Preparing reports and negotiating settlements

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 Expert(e) en sinistres – Automobile / Auto Claims Adjuster OBJECTIF PRINCIPAL : Sous la supervision du vice-président régional, l’expert(e) en sinistres - automobile doit fournir un niveau de service élevé et constant en faisant enquête sur les réclamations des assureurs ou des tiers et en négociant le règlement des réclamations d’une manière satisfaisante pour toutes les parties. FONCTIONS ESSENTIELLES et RESPONSABILITÉS : - Gérer une enquête de bureau complète sur les réclamations qui lui sont confiées tout en respectant les normes de qualité de l’entreprise, y compris l’obtention de tous les détails sur la perte subie et des informations pertinentes, la détermination de la couverture et de la validité des réclamations, la communication avec les assurés et les requérants, la préparation des rapports et la négociation des règlements. - Maintenir des dossiers exacts en conformité avec les normes et les procédures de l’entreprise, au moyen des systèmes informatiques spécialisés de l’entreprise. - Déterminer le besoin et la méthode de coordination de l’assignation des mandats en collaboration avec les experts route. - Examiner et interpréter les termes des polices afin de confirmer et de mettre en application la protection pour les pertes subies. - Gérer de manière précise et efficace la facturation des dossiers attribués, en fonction des échéanciers établis. - Maintenir une excellente relation de travail avec les clients existants, de manière à développer nos affaires. - Suivre des cours de formation continue afin d’être au courant des questions et des changements qui touchent le secteur et les lois. AUTRES FONCTIONS et RESPONSABILITÉS : - S’acquitter d’autres fonctions attribuées. QUALIFICATIONS : Formation et accréditations - Études postsecondaires. - Bilingue (français et anglais) - Obtention ou travail en vue de l’obtention d’un titre de PAA. - Licence ou capacité d’obtenir une licence provisoire. - Permis de conduire valable. Expérience - 3 à 5 ans d’expérience - Expérience avec les marchandises (atout) - Compétences avérées en matière d’expertise en sinistres, de négociation et d’analyse - Excellentes compétences interpersonnelles et de communication - Compétences informatiques avancées, y compris avec Office, Outlook et les applications Web Nous nous sommes engagés à mettre en place des processus de recrutement et de sélection inclusifs et sans obstacles. Si l’on vous contacte pour une offre d’emploi, veuillez communiquer avec les Ressources collègues si vous avez besoin de mesures d’adaptation. PRIMARY PURPOSE: Reporting to the National Manager, the Claims Adjuster, Auto is responsible for providing a consistently high level of service by investigating insurance claims for insurers or third parties and negotiating settlement of the claims to the satisfaction of all parties. ESSENTIAL FUNCTIONS and RESPONSIBILITIES: - Manages comprehensive desktop investigation of assigned claims while meeting company standards and quality, including obtaining all required loss details and relevant information; determining coverage and validity of claims, and communicating with insured and claimants; preparing reports and negotiating settlements - Maintains accurate records based on company standards and procedures, using company custom computer systems - Identifies the need and co-ordination of task assignments utilizing field adjusters - Reviews and interprets policy wording to confirm and apply coverage of losses - Accurately and efficiently manages the billing for assigned files, within specified timelines - Maintains an excellent working relationship with existing clients to further develop business - Committed to continuous education to keep up-to-date with all industry and legislative issues and changes ADDITIONAL FUNCTIONS and RESPONSIBILITIES: - Performs other duties as assigned. QUALIFICATIONS: Education & Licensing - Manages comprehensive desktop investigation of assigned claims while meeting company standards and quality, including obtaining all required loss details and relevant information; determining coverage and validity of claims, and communicating with insured and claimants; preparing reports and negotiating settlements - Maintains accurate records based on company standards and procedures, using company custom computer systems - Identifies the need and co-ordination of task assignments utilizing field adjusters - Reviews and interprets policy wording to confirm and apply coverage of losses - Accurately and efficiently manages the billing for assigned files, within specified timelines - Maintains an excellent working relationship with existing clients to further develop business - Committed to continuous education to keep up-to-date with all industry and legislative issues and changes Experience - 3 to 5 year experience - Cargo experience an asset - Proven adjusting, negotiating skills and analytical skills - Excellent interpersonal and communication skills - Advanced computer skills including office, outlook and web based applications Skills & Knowledge - 3 to 5 year experience - Cargo experience an asset - Proven adjusting, negotiating skills and analytical skills - Excellent interpersonal and communication skills - Advanced computer skills including office, outlook and web based applications 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. 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 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.