Claims Examiner

We are seeking a highly skilled Claims Examiner to join our team at Sedgwick. As a Claims Examiner, you will play a critical role in analyzing low- and mid-level workers compensation claims to determine benefits due and ensuring ongoing adjudication of claims within company standards and industry best practices.

• Adjust medical-only claims and low- to mid-level lost-time workers compensation claims under close supervision.
• Support other claims staff with larger or more complex claims as necessary.
• Process workers compensation claims reviewing compensability, benefits due, and files necessary documentation with state agency.
• 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.

• High School diploma or GED required. Licenses as required.
• One (1) year of claims management experience or equivalent combination of education and experience required.
• Excellent oral and written communication 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. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts.

We are 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.