Offer summary

Qualifications:

Bachelor's degree from an accredited university is preferred., At least four years of claims management experience or equivalent., In-depth knowledge of insurance principles, recoveries, and cost containment., Excellent communication, organizational, and analytical skills..

Key responsibilities:

Analyze and process complex workers' compensation claims.

Manage claims through investigation, action plans, and timely resolution.

Coordinate with vendors, legal, and medical contacts for claim management.

Ensure proper documentation, compliance, and client communication.

Job description

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Senior Claims Examiner

PRIMARY PURPOSE: To analyze complex or technically difficult workers compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; and to ensure ongoing adjudication of claims within company standards and industry best practices or client specific requirements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Analyzes and processes complex or technically difficult claims by investigating and gathering information to assist employer in determining their position on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
Works to move claim towards appropriate claim closure which may include referral for settlement evaluation.
Monitors reserve adequacy throughout the life of the claim if applicable.
Monitors and reviews benefits due and payment calculations ensuring accuracy.
Prepares necessary state filings within statutory limits.
Follows best practice standards in contested claims including outside legal representation.
Coordinates vendor referrals for additional investigation and/or litigation management.
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
Participates in claim recoveries including, but not limited to: subrogation, Second Injury Fund recoveries, and Social Security offsets.
Communicates claim action/processing with appropriate parties including, but not limited to: claimant, client, state agency, managed care organization and appropriate medical contact.
Ensures claims files are properly documented and claims coding is correct.
Maintains professional client relationships.
Coordinates actuarial/settlement issues impacting employers with rate and settlement departments.
Assesses policy level status of clients; works in coordination with clients' service expectations and assigned service personnel.

ADDITIONAL FUNCTIONS AND RESPONSIBILITIES

Performs other duties as assigned.
Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line-of-business preferred.

Experience

Four (4) years claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

In-depth line-of-business knowledge of appropriate insurance principles and laws, recoveries offsets and deductions, and cost containment principles
Excellent oral and written communication skills, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Good interpersonal skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.