Workers Compensation Consultant

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top CompaniesCertified as a Great Place to Work®Fortune Best Workplaces in Financial Services & InsuranceWorkers Compensation Consultant - Level 2We’re hiring Workers’ Compensation Consultants If you have experience handling Workers Compensation claims across Canadian jurisdictions—or background in absence management, leave administration, STD/LTD adjudication—we’d love to have you on our team.Ideal candidates will bring:Paralegal expertise for handling claims, appeals, and compliance mattersStrong knowledge of workers’ compensation legislation and health & safety standardsProven ability to manage complex claims processes and collaborate with stakeholdersExperience in HR leave programs, disability case management, and policy interpretationIf you are passionate about supporting colleagues through challenging times and ensuring compliance, we want to hear from youPRIMARY PURPOSE: To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.ESSENTIAL FUNCTIONS and RESPONSIBILITIESManages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts and approves claim payments.Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.Manages subrogation of claims and negotiates settlements.Communicates claim action with claimant and client.Ensures 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.Maintains professional client relationships.ADDITIONAL FUNCTIONS AND RESPONSIBILITIESPerforms other duties as assigned.Supports the organization's quality program(s).Travel as required.QUALIFICATIONSEducation & LicensingBachelor's degree from an accredited college or university preferred.ExperienceFour (4) years of claims management experience or equivalent combination of education and experience required.Skills & KnowledgeWorking knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of businessExcellent oral and written communication, including presentation skillsPC literate, including Microsoft Office productsAnalytical and interpretive skillsStrong organizational skillsGood interpersonal skillsExcellent negotiation skillsAbility to work in a team environmentAbility to meet or exceed Service ExpectationsThe statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.Where applicable, Sedgwick uses artificial intelligence tools to assist in the screening, assessment, or selection of candidates. These tools are subject to periodic review.We are committed to inclusive, barrier-free recruitment and selection processes. If contacted for an employment opportunity, please advise Colleague Resources if you require accommodation.Sedgwick is an Equal Opportunity Employer.The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Sedgwick retains the discretion to add or to change the duties of the position at any time.