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Risk Management Claims Professional
2 months ago
We are seeking a highly skilled and experienced Claims Adjuster - Workers Compensation Specialist to join our team at Sedgwick. As a key member of our claims management team, you will be responsible for analyzing and processing complex workers' compensation claims, ensuring timely and cost-effective resolution.
Key Responsibilities- Analyze and process complex workers' compensation claims, investigating and gathering information to determine exposure and manage claims through well-developed action plans.
- Negotiate settlements within designated authority and calculate and assign timely and appropriate reserves to claims.
- 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 and manage the litigation process, ensuring timely and cost-effective claims resolution.
- Coordinate vendor referrals for additional investigation and/or litigation management, and use appropriate cost containment techniques 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, and refer cases as appropriate to supervisor and management.
- Bachelor's degree from an accredited college or university preferred, with 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, and PC literate, including Microsoft Office products.
- Analytical and interpretive skills, strong organizational skills, good interpersonal skills, excellent negotiation skills, and ability to work in a team environment.
When applicable and appropriate, consideration will be given to reasonable accommodations. The successful candidate will be required to work in a fast-paced environment, handling multiple priorities simultaneously and meeting deadlines.
