Note: The job is a remote job and is open to candidates in USA. Sedgwick is a global industry leader in claims management services. The Workers Compensation Claims Examiner will analyze complex claims, negotiate settlements, and ensure timely resolution while maintaining professional relationships with clients and claimants.
Responsibilities
- Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution
- Negotiates settlement of claims within designated authority
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level
- Prepares necessary state fillings within statutory limits
- Manages the litigation process; ensures timely and cost effective claims resolution
- Coordinates vendor referrals for additional investigation and/or litigation management
- Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients
- Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets
- Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner
- Communicates claim activity and processing with the claimant and the client; maintains professional client relationships
- Ensures claim files are properly documented and claims coding is correct
- Refers cases as appropriate to supervisor and management
Skills
- Five (5) years of claims management experience or equivalent combination of education and experience required
- California jurisdictional knowledge required
- SIP required or must be obtained within one (1) year of employment
- Bachelor's degree from an accredited college or university preferred
- Professional certification as applicable to line of business preferred
Benefits
- Medical
- Dental
- Vision
- 401K on day one
- PTO
- Disability and life insurance
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
Company Overview
Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected. It was founded in 1969, and is headquartered in Memphis, Tennessee, USA, with a workforce of 10001+ employees. Its website is http://www.sedgwick.com.