Claims Examiner – Workers Comp
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Job Description
Claims Examiner analyzing complex workers' compensation claims with a focus on benefits determination. Join Sedgwick, a global leader in risk and claims management solutions, and apply your expertise.
Responsibilities:
- Analyze complex or technically difficult workers' compensation claims to determine benefits due.
- Work with high exposure claims involving litigation and rehabilitation.
- Ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements.
- Identify subrogation of claims and negotiate settlements.
- 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 claims within designated authority level.
- Prepares necessary state fillings within statutory limits.
- Manages the litigation process; ensures timely and cost effective claims resolution.
Requirements:
- 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.
Benefits:
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
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