Claims Examiner
5 days ago
Sedgwick is a leading provider of technology-enabled risk, benefits, and integrated business solutions. We are seeking a highly skilled Claims Examiner to join our team of talented professionals.
Key Responsibilities- Analyze mid- and higher-level general liability claims to determine benefits due
- Ensure ongoing adjudication of claims within company standards and industry best practices
- Identify subrogation of claims and negotiate settlements
- Manage mid-level general liability claims by gathering information to determine liability exposure
- Assign reserve values to claims, make claims payments as necessary, and settle claims up to designated authority level
- Assess liability and resolve claims within evaluation
- Approve and process assigned claims, determine benefits due, and manage action plan pursuant to the claim or client contract
- Manage subrogation of claims and negotiate settlements
- Communicate claim action with claimant and client
- Ensure claim files are properly documented and claims coding is correct
- May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review
- Maintain professional client relationships
- Bachelor's degree from an accredited college or university preferred
- Four (4) 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.
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Workers Compensation Claims Examiner
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Workers Compensation Claims Examiner
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Roseville, California, United States Sedgwick Full timeAbout the RoleSedgwick is seeking a highly skilled Workers Compensation Claims Examiner to join our team. As a Claims Examiner, you will play a critical role in analyzing and processing complex workers' compensation claims, ensuring timely and cost-effective resolution for our clients.Key ResponsibilitiesAnalyze and process complex workers' compensation...
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