Claims Examiner

3 weeks ago

Brea, California, United States Sedgwick Full time
About the Role

Sedgwick is seeking a skilled Claims Examiner to join our team. As a Claims Examiner, you will play a critical role in analyzing complex workers' compensation claims and determining benefits due. Your expertise will be essential in managing claims through well-developed action plans to achieve timely and appropriate resolutions.

Key Responsibilities
  • Analyze and process complex workers' compensation claims by investigating and gathering information to determine exposure on the claim.
  • Manage claims through well-developed action plans to achieve timely and appropriate resolutions.
  • Negotiate settlement of claims within designated authority.
  • Calculate and assign timely and appropriate reserves to claims.
  • Calculate and pay benefits due, approve and make timely claim payments and adjustments, and settle claims within designated authority level.
  • Prepare necessary state filings within statutory limits.
  • Manage the litigation process to 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.
Requirements
  • Bachelor's degree from an accredited college or university preferred.
  • Professional certification as applicable to line of business 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.
  • Excellent oral and written communication, including presentation skills.
  • 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.
Work Environment

This role requires a strong analytical mind and excellent communication skills. You will work in a fast-paced environment with multiple priorities and deadlines. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

We offer a comprehensive benefits package, 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.

If you're excited about this role and have the skills and experience required, we encourage you to apply. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.

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