[Hiring] Claims Examiner - Workers Compensation @Sedgwick Claims Management Services Inc.
Mar 25, 2025 - Sedgwick Claims Management Services Inc. is hiring a remote Claims Examiner - Workers Compensation. đź’¸ Salary: unspecified. đź“ŤLocation: USA.
Role Description
This role involves analyzing complex or technically difficult workers' compensation claims to determine benefits due and managing high exposure claims involving litigation and rehabilitation.
- Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
- Manage claims through well-developed action plans to an appropriate and timely resolution.
- Negotiate settlement of claims within designated authority.
- Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
- Calculate and pay benefits due; approve and make timely claim payments and adjustments; settle claims within designated authority level.
- Prepare necessary state filings within statutory limits.
- Manage the litigation process; ensure timely and cost-effective claims resolution.
- Coordinate vendor referrals for additional investigation and/or litigation management.
- Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for clients.
- Manage claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
- Report claims to the excess carrier; respond to requests for directions in a professional and timely manner.
- Communicate claim activity and processing with the claimant and the client; maintain professional client relationships.
- Ensure claim files are properly documented and claims coding is correct.
- Refer cases as appropriate to supervisor and management.
Qualifications
- Bachelor's degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
- Five (5) years of claims management experience or equivalent combination of education and experience required.
Requirements
- 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.
Company Description
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions.
- More than 30,000 colleagues across 80 countries.
- Committed to doing the right thing – one where caring counts.
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| đź“Ť | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
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Salary
đź’¸
unspecified
|
Remote
Location
USA
|
|
Job Type
unspecified
|
Posted
Mar 25, 2025
|
| đź“Ť | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
