一般责任理赔员

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General Liability AdjusterPrimary Purpose
The Commercial General Liability (CGL) Claims Adjuster is responsible for the end-to-end handling of complex third-party bodily injury and property damage claims arising under commercial general liability policies. This role requires advanced expertise in coverage analysis, liability determination, litigation management, and risk transfer, particularly across multi-jurisdictional and construction-related exposures. The adjuster is expected to proactively manage claim outcomes, control loss costs, and ensure compliance with client service standards, regulatory requirements, and internal quality expectations.
Essential Functions and Responsibilities
· Claim Investigation & File Ownership

• Independently investigate and manage a full caseload of CGL claims, including but not limited to premises liability, slip and fall, product liability, construction defect and construction-related losses, and contractual liability exposures.

• Drive timely claim resolution through proactive file management, strategic planning, and adherence to best practices in diary management and documentation.

• Coverage Analysis & Policy Interpretation

• Analyze complex policy language, including insuring agreements, endorsements, exclusions (e.g., ongoing/completed operations, additional insured provisions), and limits to determine coverage applicability.

• Draft clear, defensible coverage position letters, including reservation of rights and denial letters, consistent with jurisdictional requirements and client expectations.

• Liability & Damages Evaluation

• Conduct comprehensive liability investigations, including:

• Review and analysis of incident reports, contracts, lease agreements, and indemnification provisions

• Identification and application of contractual risk transfer provisions

• Obtaining and evaluating recorded statements, expert opinions, photographs, and surveillance

• Evaluate injury severity, medical treatment, and long-term exposure, including review of medical records, bills, and independent medical evaluations (IMEs) where applicable.

• Establish, maintain, and adjust reserves in accordance with claim developments and severity exposure.

• Litigation Management

• Manage litigated files, including the retention and direction of defense counsel.

• Provide strategic oversight on litigation plans, budgets, pleadings, discovery, and dispositive motions.

• Participate in mediations, settlement conferences, and trial preparation, ensuring alignment with client and organizational strategies.

• Settlement & Negotiation

• Negotiate settlements within delegated authority while balancing cost containment and risk exposure.

• Evaluate settlement value based on liability, damages, venue, and litigation risks, and escalate appropriately when exceeding authority.

• Risk Transfer & Subrogation

• Identify, evaluate, and pursue risk transfer opportunities, including:

• Additional insured tenders

• Contractual indemnity provisions

• Subrogation potential

• Coordinate with coverage counsel, carriers, and third parties to maximize recovery and proper allocation of liability.

• Client & Stakeholder Communication

• Maintain proactive, professional communication with insureds, claimants, brokers, clients, and internal stakeholders.

• Provide detailed status updates, large loss reports, and claim summaries tailored to client-specific reporting requirements.

• Documentation, Compliance & Quality

• Maintain thorough, accurate, and timely file documentation to support claim decisions and audit readiness.

• Ensure compliance with applicable state regulations, client service instructions, and internal audit and quality standards.

• Participate in internal and external audits, file reviews, and continuous improvement initiatives.

Additional Functions and Responsibilities
· Support organizational quality initiatives, audit programs, and operational excellence efforts.

• Contribute to process improvement, knowledge sharing, and team development activities as needed.

• Perform other duties as assigned.

Qualifications

Education & Licensing
· Bachelor’s degree or equivalent work experience.

• Adjuster licensing as required by jurisdiction(s) handled.

Experience
· Minimum of 5+ years of commercial general liability claims handling experience required; experience with litigated and construction-related claims strongly preferred.

Skills & Knowledge
· Strong understanding of CGL coverage, policy interpretation, and jurisdictional differences

• Experience managing litigated claims and working with defense counsel

• Knowledge of construction defect, additional insured coverage, and risk transfer strategies

• Ability to assess liability, damages, and exposure in complex loss scenarios

• Strong negotiation and settlement skills

• Excellent written and verbal communication, including drafting coverage correspondence and client reports

• Proficiency in claims systems and Microsoft Office applications

• Demonstrated organization, attention to detail, and time management

• Ability to work both independently and collaboratively in a fast-paced, team-driven environment

• Proven ability to meet or exceed performance, quality, and compliance metrics

WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
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.
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.
Originally posted on Himalayas