Conseiller / Conseillère en indemnisation des accidents du travail – Niveau 2
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Job Description
Workers’ compensation consultant managing complex Canadian claims for Sedgwick, a global risk and claims administration partner. Handling adjudication, litigation, settlements, recoveries, and client communications.
Responsibilities:
- Analyze and process complex or technically difficult workers' compensation claims
- Investigate and gather information to determine claim exposure
- Manage claims through action plans to timely and appropriate resolution
- Negotiate claim settlements within designated authority
- Calculate and assign timely, appropriate claim reserves and manage reserve adequacy
- Calculate and pay benefits, approve claim payments and adjustments, and settle claims within authority
- Prepare necessary statutory filings within statutory limits
- Manage litigation processes for timely and cost-effective resolution
- Coordinate vendor referrals for investigation or litigation management
- Apply cost-containment techniques and strategic vendor partnerships
- Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets
- Report claims to excess carriers and respond to direction requests
- Communicate claim activity with claimants and clients and maintain professional client relationships
- Ensure claim files are properly documented and claims coding is correct
- Refer cases to supervisors and management when appropriate
- Support organizational quality programs
- Perform other assigned duties
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
- Subject matter expertise in insurance principles and laws, recoveries, offsets and deductions, claim and disability duration, cost containment principles, medical management practices, and Social Security and Medicare application procedures as applicable
- Excellent oral and written communication, including presentation skills
- PC literacy, 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
- Ability to travel as required
Benefits:
- Work-life balance
- Inclusive, barrier-free recruitment and selection processes
- Accommodation support during recruitment, if required
- Equal opportunity employment
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