Claims Examiner

Sedgwick is a leading global provider of technology-enabled risk, benefits, and integrated business solutions. Our mission is to help organizations protect their employees, customers, and assets while minimizing business interruptions.

We are seeking a skilled Claims Examiner to join our team. As a Claims Examiner, you will be responsible for analyzing complex workers' compensation claims, determining benefits due, and ensuring ongoing adjudication of claims within company standards and industry best practices.

• Analyze and process complex claims by investigating and gathering information to assist employers in determining their position on the claim.
• Manage claims through well-developed action plans to achieve timely resolution.
• Monitor reserve adequacy throughout the life of the claim, if applicable.
• Monitor and review benefits due and payment calculations to ensure 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 cost containment techniques to reduce the overall cost of claims for our clients.
• Participate in claim recoveries, including subrogation, Second Injury Fund recoveries, and Social Security offsets.
• Communicate claim action/processing with relevant parties, including claimants, clients, state agencies, managed care organizations, and medical contacts.
• 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.

• Bachelor's degree from an accredited college or university preferred.
• Licenses as required.
• Professional certification as applicable to the line of business preferred.
• Four (4) years of claims management experience or equivalent combination of education and experience required.

Sedgwick offers a comprehensive benefits package, including medical, dental, vision, 401(k) and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

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, consider applying anyway. We're building a diverse, equitable, and inclusive workplace and recognize that each person possesses a unique combination of skills, knowledge, and experience.