Workers Compensation Claims Examiner
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Job Description
Workers compensation claims examiner adjudicating complex lost-time claims for Sedgwick's global insurance services. Investigating exposure, negotiating settlements, and communicating resolutions across New England jurisdictions.
Responsibilities:
- Analyze lost-time workers compensation claims on behalf of clients to determine benefits due
- Ensure ongoing adjudication of claims within service expectations, industry best practices, and client service requirements
- Investigate claims and gather information to determine claim exposure
- Process claims through action plans toward appropriate and timely resolution
- Negotiate claim settlements within designated authority
- Communicate claim activity and processing with claimants and clients
- Report claims to excess carriers
- Respond to requests for directions professionally and timely
- Leverage Sedgwick's global network of experts to learn and share insights
- Deliver customer-facing solutions to clients across industries
Requirements:
- High School Diploma or GED required
- Bachelor's degree from an accredited college or university preferred
- Professional certification as applicable to line of business preferred
- 5 years of claims management experience or equivalent combination of education and experience required
- Knowledge of workers compensation jurisdictions: MA, CT, NH, RI, VT
- Licensing: VT, CT, NH, RI
- Ability to analyze and process lost-time workers compensation claims
- Ability to investigate claims and gather information to determine exposure
- Ability to negotiate claim settlements within designated authority
- Ability to communicate claim activity with claimants and clients
- Ability to report claims to excess carriers and respond to direction requests
- Clear and conceptual thinking ability
- Excellent judgment, troubleshooting, problem-solving, analysis, and discretion
- Ability to handle work-related stress and multiple priorities
- Ability to meet deadlines
- Computer keyboarding
- Hearing, vision, and talking
Benefits:
- Flexible work schedule
- Referral incentive program
- Opportunity to work in an agile environment
- Career development and promotional growth opportunities
- Medical, dental, and vision insurance
- 401K and matching
- PTO
- Disability and life insurance
- Employee assistance program
- Flexible spending or health savings account
- Other additional voluntary benefits
- Remote work flexibility and autonomy
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