Compensation Claims Examiner

6 days ago

San Diego, California, United States Sedgwick Full time
About the Role

We are seeking a highly skilled Claims Adjuster Workers Compensation Specialist to join our team at Sedgwick. As a key member of our organization, you will play a critical role in analyzing and managing workers compensation claims to ensure accurate and timely benefits are provided to our clients.

Key Responsibilities
  • Analyze mid- and higher-level workers compensation claims to determine benefits due and ensure ongoing adjudication within company standards and industry best practices.
  • Develop and manage workers compensation claims' action plans to resolution, coordinate return-to-work efforts, and approve claim payments.
  • Manage subrogation of claims and negotiate settlements.
  • Communicate claim action with claimants and clients.
  • Ensure 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.
  • Maintain professional client relationships.
Requirements
  • Bachelor's degree from an accredited college or university preferred.
  • Four (4) years of claims management experience or equivalent combination of education and experience required.
  • Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business.
  • Excellent oral and written communication, including presentation skills.
  • PC literate, including Microsoft Office products.
  • Analytical and interpretive skills.
  • Strong organizational skill.
  • Good interpersonal skills.
  • Excellent negotiation skills.
  • Ability to work in a team environment.
  • Ability to meet or exceed Service Expectations.
Work Environment

This role requires the ability to work in a fast-paced environment and handle multiple priorities simultaneously. The successful candidate will have excellent analytical and problem-solving skills, as well as strong communication and interpersonal skills. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

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