Claims Examiner – Workers Comp
Employment Information
Report this job
Job expired or something wrong with this job?
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.
Report this job
Job expired or something wrong with this job?
Similar Jobs
Health Claims Examiner Coach
Health Claims Examiner Coach at Cigna Healthcare focused on processing health claims and mentoring examiners. Ensuring compliance and collaboration with providers.
Claims Coordinator
Claims Coordinator managing dispatch and resolution of vehicle claims for Dent Wizard. Ensuring timely communication with technicians, vendors, and customers, while supporting administrative tasks.
Commercial Property Claims Examiner III
Commercial Property Claims Examiner managing and authorizing complex commercial insurance claims investigated by independent adjusters. Focusing on claims over $500,000 with a detailed examination process.
Claims Analyst
Claims Analyst managing the preparation and filing of reimbursement claims for mortgage-related entities at Valon. Collaborating with Default Servicing team to ensure compliance and efficiency.
Healthcare Claims Examiner, RN Required
Healthcare Claims Examiner evaluating beneficiaries' admission to nursing facilities for General Dynamics Information Technology. Ensuring accurate documentation and compliance with medical necessity criteria in a remote capacity.
Senior Claims Specialist
Claims Specialist resolving high-complexity claims, ensuring timely and accurate resolution while collaborating with stakeholders. Working at Berkley Small Business Solutions, focused on small business insurance.
Claims Analyst I
Claims Analyst specializing in identifying and recovering claim overpayments for health insurance clients. Collaborating within a dynamic team to enhance payment accuracy and healthcare access.
Claims Specialist, Bilingual French Preferred
Claims Specialist processing new claims requests for vehicle protection plans. Requires attention to detail and excellent customer service in a call center environment.
L&A Claims Examiner
Claims Examiner in charge of documenting calls and analyzing claim eligibility. Collaborating with stakeholders to ensure accurate processing of payments and managing claim inventories.
Senior Claims Specialist
Claims Specialist analyzing and processing insurance claims to ensure accuracy and compliance at CVS Health. Collaborating on claims data analysis and improving customer satisfaction through effective communication.
Property Claims Examiner I
Claims Examiner I processing property insurance claims up to $100,000 remotely. Collaborating with adjusters and ensuring compliance with company policies and regulations.
Disability Claims Examiner
Paid Family Leave Claim Examiner managing Absence and Paid Leave claims for Prudential. Responsible for ensuring optimal claims handling and customer-focused service in a metrics-driven environment.
Senior Claims Analyst
Senior Claims Analyst responsible for managing oversight and claims processes in youth sports technology. Requires strong insurance and analytical skills with leadership responsibilities.
Claims Adjuster
Claims Adjuster at Davies North America handling General Liability and Auto Liability claims. Seeking candidates with 5 years experience and a Florida adjuster license.
Casualty Claims Adjuster I
Casualty Claims Adjuster ensuring accurate claims processing and effective communication with insureds and claimants. Managing coverage, liability assessments, and negotiating settlements.
Health Claims Examiner
Claims Examiner processing medical, dental, vision, and prescription drug claims for Cigna Healthcare. Responsible for ensuring accurate and timely claim processing while providing excellent customer service.
VA Claims Specialist II
Serve as primary contact for VA disability appeal inquiries, providing education and resolving claimant issues. Review questionnaires and perform data entry in a support role for the Department of Veterans Affairs.
Property Claims Specialist
Property Claims Specialist working remotely with Coterie on commercial property claims resolution. Collaborating with stakeholders and developing strategies for efficient claims management.
Claims Specialist
Claims Specialist managing all aspects of claims management for logistics operations at Charger Logistics Inc. Focused on subrogation recovery and minimizing liability exposure.
Claims Specialist
Claims Specialist resolving medical claims that do not auto-adjudicate for Arkansas Blue Cross. Timely and accurate handling of claims processing along with necessary investigations.