Workers Compensation Claims Examiner
4 weeks ago
Job Summary
Sedgwick is seeking a skilled Workers Compensation Claims Examiner to join our team. As a Claims Examiner, you will be responsible for analyzing complex workers' compensation claims to determine benefits due. Your expertise will be essential in managing claims through well-developed action plans to achieve timely and cost-effective resolutions.
Key Responsibilities
- Analyze complex or technically difficult workers' compensation claims to determine benefits due
- Work with high exposure claims involving litigation and rehabilitation
- Ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements
- Identify subrogation of claims and negotiate settlements
- Manage claims through well-developed action plans to achieve timely and cost-effective resolutions
- Negotiate settlement of claims within designated authority
- Calculate and assign timely and appropriate reserves to claims
- Manage reserve adequacy throughout the life of the claim
- Approve and make timely claim payments and adjustments
- Manage the litigation process
- Ensure timely and cost-effective claims resolution
- Coordinate vendor referrals for additional investigation and/or litigation management
- Use appropriate cost containment techniques to reduce overall cost of claims for our clients
- Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets
- Report claims to the excess carrier
- Communicate claim activity and processing with the claimant and the client
- Ensure claim files are properly documented and claims coding is correct
Requirements
- Bachelor's degree from an accredited college or university preferred
- Five (5) years of claims management experience or equivalent combination of education and experience required
- 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, including medical management practices, and Social Security and Medicare application procedures as applicable to line-of-business
- PC literate, including Microsoft Office products
- Excellent judgment, troubleshooting, problem-solving, analysis, and discretion
- Computer keyboarding, travel as required
Auditory/Visual:
Hearing, vision, and talking
Security Clearance:
Credit security clearance, confirmed via a background credit check, is required for this position
Benefits:
A comprehensive benefits package is offered, including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits
-
Workers Compensation Claims Examiner
4 weeks ago
Roseville, California, United States Sedgwick Full timeJob SummaryWe are seeking a highly skilled Workers Compensation Claims Examiner to join our team at Sedgwick. As a key member of our claims team, you will be responsible for analyzing and processing complex workers' compensation claims, ensuring timely and accurate resolution of claims, and providing exceptional customer service to our clients.Key...
-
Claims Manager Workers Compensation Professional
4 weeks ago
Roseville, California, United States Sedgwick Full timeClaims Manager Workers CompensationAt Sedgwick, we prioritize taking care of our colleagues and clients. As a Claims Manager Workers Compensation, you will be responsible for managing the technical and operational functions within a dedicated client, ensuring consistent delivery of quality services, managing staffing and training needs, and overseeing budget...
-
Claims Specialist
4 weeks ago
Roseville, California, United States CorVel Enterprise Comp, Inc. Full timeJob SummaryWe are seeking a highly skilled Claims Specialist to join our team at CorVel Enterprise Comp, Inc. The ideal candidate will have a strong background in workers' compensation claims management and excellent communication skills.Key Responsibilities:Manage workers' compensation claims from inception to closure, ensuring timely and accurate...
-
Roseville, California, United States Zenith Insurance Company Full timeJob SummaryWe are seeking a skilled Travel Nurse Consultant to join our team at Zenith Insurance Company. In this role, you will be responsible for conducting field case management, disability management, and utilization review for injured workers to return them to employability and normal activities or achieve maximum medical improvement (MMI).Key...
-
Claims Adjuster Trainee
4 weeks ago
Roseville, California, United States PMA Companies Full timeThe Claims Apprentice Program at PMA Companies is a nine-month training opportunity for recent college graduates interested in a career as a Claims Adjuster in the Property & Casualty insurance industry.As a Claims Apprentice, you will be trained by PMA's team of claims experts and leaders, developing your skills and knowledge in workers' compensation and/or...
-
Claims Adjuster Trainee
4 weeks ago
Roseville, California, United States PMA Companies Full timeClaims Apprentice ProgramThe Claims Apprentice Program is an exciting opportunity for recent college graduates interested in a career as a Claims Adjuster in the Property & Casualty insurance industry. As a Claims Apprentice, you will be trained by PMA's team of claims experts and leaders.Job Responsibilities:Promptly investigate assigned claims, determining...
-
Service Warranty Claims Specialist
4 weeks ago
Roseville, California, United States AutoNation Full timeService Warranty Administrator Job DescriptionAutoNation is one of the largest automotive retailers in the United States, offering innovative products, exceptional services, and comprehensive solutions, empowering our customers to make the best decisions for their needs.As a Service Warranty Administrator, you will play a critical role in reviewing and...
-
Associate Attorney
3 weeks ago
Roseville, California, United States Nyman Turkish PC Full timeJob DescriptionAt Nyman Turkish PC, we are a nationally recognized, full-service law firm with over 45 years of experience specializing in Social Security Disability and Workers' Compensation. Our dedicated team, led by renowned civil rights experts, has successfully recovered tens of millions of dollars in benefits for thousands of claimants.Why Choose...
-
Senior Clinical Social Worker Specialist
3 weeks ago
Roseville, California, United States Sutter Health Full timeSutter Health is currently seeking a highly skilled and compassionate Senior Clinical Social Worker Specialist to join our team in providing exceptional patient care and support.The ideal candidate will have a Master's degree in Social Work and at least 2 years of recent relevant experience in clinical social work. They will possess strong clinical skills in...
-
Medical Social Worker
4 weeks ago
Roseville, California, United States Sutter Visiting Nurse Association and Hospice Full timeWe are seeking a skilled Medical Social Worker to join our team at Sutter Visiting Nurse Association and Hospice.Job Summary:The Medical Social Worker will assess social and emotional factors related to patients' illnesses, medical, and nursing requirements in the home. They will develop and implement a plan for home social work services, including education...
-
Family Medicine Physician
4 weeks ago
Roseville, California, United States Dignity Physician Careers Full timeOpportunity OverviewAt Dignity Physician Careers, we are seeking a highly skilled Family Medicine Physician to join our team at our brand new Express Care Clinic in Roseville, CA. This is an exciting opportunity to provide high-quality patient care in a fast-paced, dynamic environment.Key HighlightsPractice will have 2 Physicians and 3 APPsWalk-in clinic...
-
Family Medicine Physician
4 weeks ago
Roseville, California, United States CommonSpirit Health Full timeOverviewMercy Medical Group, a dynamic and growing organization, is seeking a Family Medicine Physician to join our Express Care Clinic in Roseville, CA. This opportunity offers a unique chance to provide high-quality patient care in a fast-paced, walk-in clinic setting.Key Highlights:Practice with a team of 2 Physicians and 3 APPsFlexible shift schedule and...
-
Family Medicine Physician
4 weeks ago
Roseville, California, United States CommonSpirit Health Full timeCommonSpirit Health is seeking a Family Medicine Physician to join our Express Care Clinic in Roseville, CA. This is an exciting opportunity to work in a dynamic, growing organization with a long-standing history of providing exceptional medical care in the Sacramento area.The Express Care Clinic is a walk-in clinic with a flexible shift schedule and...
-
Primary Care Physician
17 hours ago
Roseville, California, United States Dignity Health Full timeAbout the RoleMercy Medical Group, a dynamic and growing organization, is seeking a highly skilled Family Medicine Physician to join our team. As a member of our esteemed medical group, you will have the opportunity to work in a patient-centric, physician-led medical home model with advanced clinical practitioners and nurses.Highlights:Patient-focused care...
-
Family Medicine Physician
4 weeks ago
Roseville, California, United States Dignity Health Full timeJob Summary:We are seeking a highly skilled and compassionate Family Medicine Physician to join our team at Dignity Health. As a Family Medicine Physician, you will be responsible for providing high-quality patient care, diagnosing and treating various medical conditions, and developing comprehensive treatment plans.Key Responsibilities:Diagnose and treat...
-
Family Medicine Physician
1 month ago
Roseville, California, United States Dignity Health Full timeOverviewMercy Medical Group, a leading multi-specialty medical group in the Sacramento region, is seeking a highly skilled Family Medicine Physician to join our dynamic team at our Roseville Clinic.As a Family Medicine Physician with Mercy Medical Group, you will have the opportunity to work in a patient-centric, physician-led medical home model with...
-
Associate Attorney
1 month ago
Roseville, California, United States Jobot Full timeAbout UsOur law firm is a leading provider of workers compensation defense services in California. With a strong focus on quality and effectiveness, we strive to deliver exceptional results for our clients.Job DetailsCompetitive salaryExcellent training and mentoring programsReasonable minimum billing requirementsSupport from experienced legal secretaries...
-
Family Medicine Physician
4 weeks ago
Roseville, California, United States CommonSpirit Health Full timeOverviewMercy Medical Group, a dynamic and growing organization, is seeking a Family Medicine Physician to join our team at our Roseville Clinic. As a member of our collegial and supportive environment, you will have the opportunity to work in a patient-centric, physician-led medical home model with advanced clinical practitioners and...
-
Family Medicine Physician
1 month ago
Roseville, California, United States Dignity Health Full timeAbout the OpportunityMercy Medical Group, a leading multi-specialty medical group in the Sacramento region, is seeking a Family Medicine Physician to join our brand new Express Care Clinic in Roseville, CA.This is an exciting opportunity to be part of a dynamic and growing organization that provides exceptional medical care to our patients. As a Family...
-
Physician - Family Medicine
4 weeks ago
Roseville, California, United States CommonSpirit Health Full timeOverviewCommonSpirit Health is seeking a Physician to join our Family Medicine Department at our Roseville Clinic. As a member of our team, you will have the opportunity to work in a patient-centric, physician-led medical home model with advanced clinical practitioners and nurses.Highlights Include:Patient-centric, physician-led medical home model with...