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Workers Compensation Claims Examiner

2 months ago

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

Sedgwick is seeking a highly skilled Workers Compensation Claims Examiner to join our team. As a key member of our claims team, you will be responsible for analyzing complex workers' compensation claims, negotiating settlements, and ensuring timely and cost-effective claims resolution.

Key Responsibilities
  • Analyze and process complex workers' compensation claims, investigating and gathering information to determine exposure and develop action plans for resolution.
  • Negotiate settlements within designated authority levels, ensuring fair and timely resolution for clients.
  • Calculate and assign reserves to claims, managing reserve adequacy throughout the claim's life cycle.
  • Prepare necessary state filings within statutory limits, ensuring compliance with regulatory requirements.
  • Manage the litigation process, ensuring timely and cost-effective claims resolution, and coordinating vendor referrals for additional investigation and/or litigation management.
  • Use cost containment techniques, including strategic vendor partnerships, to reduce overall claim costs for clients.
  • Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
  • Communicate claim activity and processing with claimants and clients, maintaining professional relationships.
  • Ensure claim files are properly documented and claims coding is accurate.
Requirements
  • Bachelor's degree from an accredited college or university, or equivalent combination of education and experience.
  • Five (5) years of claims management experience, or equivalent combination of education and experience.
  • Subject matter expertise in insurance principles and laws, recoveries offsets and deductions, claim and disability duration, cost containment principles, and Social Security and Medicare application procedures.
  • Excellent oral and written communication, including presentation skills.
  • PC literate, including Microsoft Office products.
  • Analytical and interpretive skills, with ability to handle multiple priorities simultaneously and meet deadlines.
What We Offer

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.

We are committed to building a diverse, equitable, and inclusive workplace, recognizing that each person possesses a unique combination of skills, knowledge, and experience. If you're excited about this role but your experience doesn't align perfectly with every qualification, consider applying anyway.