Claims Examiner Workers Compensation Specialist
8 hours ago
Sedgwick is seeking a skilled Claims Examiner Workers Compensation to join our team. As a Claims Examiner Workers Compensation, 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.
- Manage reserve adequacy throughout the life of the claim.
- 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, including strategic vendor partnerships, 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, maintaining professional client relationships.
- Ensure claim files are properly documented and claims coding is correct.
- Refer cases as appropriate to supervisor and management.
- 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, 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.
- Ability to work in a team environment.
- Ability to meet or exceed Service Expectations.
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
Physical: Computer keyboarding, travel as required.
Auditory/Visual: Hearing, vision, and talking.
NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings.
Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location.
For the jurisdiction noted in this job posting only, the range of starting pay for this role is $75,000 - $100,000 per year.
A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway. 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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