Claims Examiner
7 days ago
Sedgwick is seeking a highly 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 ensure that claims are managed effectively, and our clients receive the best possible service.
Key Responsibilities- Analyze and process complex workers' compensation claims, investigating and gathering information to determine exposure and manage claims through well-developed action plans.
- Negotiate settlements within designated authority and 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 and manage the litigation process to ensure timely and cost-effective claims resolution.
- Coordinate vendor referrals for additional investigation and/or litigation management and 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 and respond to requests and directions in a professional and timely manner.
- Communicate claim activity and processing with the claimant and the client and maintain professional client relationships.
- Ensure claim files are properly documented and claims coding is correct and refer cases as appropriate to supervisor and management.
- Bachelor's degree from an accredited college or university preferred, with 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, 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.
- 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, and ability to work in a team environment.
When applicable and appropriate, consideration will be given to reasonable accommodations. The successful candidate will be able to work in a fast-paced environment, handle multiple priorities simultaneously, and meet deadlines. The role requires excellent judgment, troubleshooting, problem-solving, analysis, and discretion, as well as the ability to handle work-related stress.
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Claims Examiner
3 weeks ago
Lake Mary, United States Sedgwick Full timeTaking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your...
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Claims Examiner
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Lake Mary, United States Sedgwick Full timeTaking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for...
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Senior Workers' Compensation Claims Examiner
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Senior Claims Examiner
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Senior Claims Examiner
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Salt Lake, Utah, United States State of Utah Full timeJob Summary:The State of Utah is seeking a highly skilled and experienced Customer Service Representative/Claims Examiner to join our team. As a Medicaid Claims Examiner II, you will be responsible for providing exceptional customer service to the medical community and public, while also processing and adjudicating claims in accordance with Medicaid...
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Lake Zurich, United States Crawford & Company Full timePosition Summary Investigate and settle advanced, large loss, complex claims promptly and equitably under minimal supervision. Works within established authority on moderate-to-difficult claims. Reviews coverages, determines liability and compensability, secures information, arranges property damage appraisals and settles claims utilizing claims best...
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Claims Resolution Expert
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Lake Zurich, United States Crawford & Company Full timeJob SummaryCrawford & Company is seeking a highly skilled Senior Claims Examiner to join our team. As a Senior Claims Examiner, you will be responsible for investigating and settling complex claims with minimal supervision.Key ResponsibilitiesClaims Investigation and AnalysisConduct thorough investigations of complex claims, gathering and analyzing data to...
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Liberty Lake, United States Korzen Health Full timeAbout the job Audiologist - Veteran Disability Assessments (C&P Examiner) Job Introduction This position is in Spokane, WA and is eligible for a relocation bonus. Join a talented team of individuals who serve this country by caring for our Nations heroes! Korzen Health is looking for a FT Audiologist to perform Veteran Audiology Examinations. Your Role You...
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Liberty Lake, United States Korzen Health Full timeAbout the job Audiologist - Veteran Disability Assessments (C&P Examiner) Job Introduction This position is in Spokane, WA and is eligible for a relocation bonus. Join a talented team of individuals who serve this country by caring for our Nations heroes! Korzen Health is looking for a FT Audiologist to perform Veteran Audiology Examinations. Your Role You...
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Liberty Lake, United States Korzen Health Full timeAbout the job Audiologist - Veteran Disability Assessments (C&P Examiner) Job Introduction This position is in Spokane, WA and is eligible for a relocation bonus. Join a talented team of individuals who serve this country by caring for our Nations heroes! Korzen Health is looking for a FT Audiologist to perform Veteran Audiology Examinations. Your Role You...
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Liberty Lake, United States Korzen Health Full timeJob DescriptionJob DescriptionJob IntroductionThis position is in Spokane, WA and is eligible for a relocation bonus. Join a talented team of individuals who serve this country by caring for our Nations heroes! Korzen Health is looking for a FT Audiologist to perform Veteran Audiology Examinations.Your RoleYou will apply your expertise in the evaluation and...
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Liberty Lake, United States Korzen Health Full time $90,000 - $110,000Job DescriptionJob DescriptionJob IntroductionThis position is in Spokane, WA and is eligible for a relocation bonus. Join a talented team of individuals who serve this country by caring for our Nations heroes! Korzen Health is looking for a FT Audiologist to perform Veteran Audiology Examinations.Your RoleYou will apply your expertise in the evaluation and...
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Litigation Associate Attorney
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Physician PRN Flexible Disability Exam Role
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Lake Charles, United States Frontera Search Partners Full timeWe’re excited to let you know about an opportunity to give back to America’s heroes and help them receive their well-deserved Veterans Affairs (VA) benefits in Lake Charles, LA.*Below are a few details about the Audiologist position:** Mon - Fri; 8am -5pm* 2-5 days per week* AT LEAST 2 DAYS PER WEEK* Pick your schedule M-F* 4-6 Veterans per 8 hour day*...
