Current jobs related to Claims Examiner - Pierre, South Dakota - Sedgwick

Sedgwick is seeking a skilled Claims Examiner to join our team. As a Claims Examiner, you will be responsible for analyzing complex workers compensation claims to determine benefits due, working with high exposure claims involving litigation and rehabilitation, and ensuring ongoing adjudication of claims within company standards and industry best practices or client specific requirements.

• Analyze and process complex or technically difficult claims by investigating and gathering information to assist employer in determining their position on the claim.
• Manage claims through well-developed action plans to an appropriate and timely resolution.
• Monitor reserve adequacy throughout the life of the claim if applicable.
• Monitor and review benefits due and payment calculations ensuring accuracy.
• Prepare necessary state filings within statutory limits.
• Follow best practice standards in contested claims including outside legal representation.
• 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.
• Participate in claim recoveries including, but not limited to: subrogation, Second Injury Fund recoveries, and Social Security offsets.
• Communicate claim action/processing with appropriate parties including, but not limited to: claimant, client, state agency, managed care organization and appropriate medical contact.
• Ensure claims files are properly documented and claims coding is correct.
• Maintain professional client relationships.
• Coordinate actuarial/settlement issues impacting employers with rate and settlement departments.
• Assess policy level status of clients; works in coordination with clients' service expectations and assigned service personnel.

• Bachelor's degree from an accredited college or university preferred.
• Licenses as required.
• Professional certification as applicable to line-of-business preferred.
• Four (4) years claims management experience or equivalent combination of education and experience required.
• In-depth line-of-business knowledge of appropriate insurance principles and laws, recoveries offsets and deductions, and cost containment principles.
• Excellent oral and written communication skills, including presentation skills.
• PC literate, including Microsoft Office products.
• Analytical and interpretive skills.
• Strong organizational skills.
• Good interpersonal skills.
• Ability to work in a team environment.
• Ability to meet or exceed Performance Competencies.

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions.