Role overview

Qualifications

5 years of claims management experience or an equivalent combination of education and experience
High School Diploma or GED
Bachelor's degree from an accredited college or university preferred
Professional certification applicable to the line of business preferred

Responsibilities

Analyze and process workers' compensation claims through action plans to timely resolution by investigating and gathering information to determine exposure
Negotiate settlements within designated authority
Communicate claim activity and processing with claimants and clients
Report claims to the excess carrier and respond to directions in a professional and timely manner

Key facts

Remote from: United States
Full time
Senior (5-10 years)
Insurance Claims Examiner
English

Hard skills

Workers' Compensation Adjudication Complaint Investigations Claims And Litigation Management Data Entry Workers' Compensation Claims Stakeholder Communications Process Management Settlement Claims And Litigation Management Customer Development Agile Software Development Diversity And Inclusion

Other skills

Decision Making
Accountability
Communication
Time Management
Teamwork
Analytical Thinking
Empathy
Growth Mindedness

About the company

EFI Global

Construction & Civil Engineering

Over the last four decades, we have grown from a boutique firm specializing in handling insurance fraud and arson cases and providing expert witness testimony, to becoming a recognized leader in engineering failure analysis, origin and cause investigations, environmental consulting, laboratory testing and specialty consulting. Each member of our multi-disciplinary team of more than 700 professional engineers, fire investigators, architects and scientists was selected for his or her technical proficiency, in-depth industry knowledge and commitment to professional integrity. Together, our diverse backgrounds and collective insights empower clients to make better-informed business decisions. This expertise, coupled with the extensive coverage of more than 62 national offices plus offices in Canada, the United Kingdom and Brazil to provide global work abroad capability, has earned us a reputation for delivering timely responses that consistently meets our clients’ expectations — anytime, anywhere. EFI Global currently provides engineering services in the state of North Carolina by our partner firm, EFI Global of North Carolina, P.C. We also provide engineering services in the states of New York and New Jersey by our partner firm, EFI Global Engineering of New York, P.C. EFI Global is part of the Sedgwick family of companies, a global leader in the independent insurance claims industry.

Company details

Company typeSME

IndustryConstruction & Civil Engineering

Company size501 - 1000

Links

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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

Claims Examiner Workers Compensation I Remote

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?

Apply your workers compensation examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.
Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.
Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
Enjoy flexibility and autonomy in your daily work, your location, and your career path.
Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

PRIMARY PURPOSE OF THE ROLE: We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

ARE YOU AN IDEAL CANDIDATE? To analyze workers compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
Negotiating settlement of claims within designated authority.
Communicating claim activity and processing with the claimant and the client.
Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

QUALIFICATIONS

Education & Licensing: 5 years of claims management experience or equivalent combination of education and experience required.

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.

Licensing / Jurisdiction Knowledge: Anywhere in the United States

TAKING CARE OF YOU

Flexible work schedule.
Referral incentive program.
Opportunity to work in an agile environment.
Career development and promotional growth opportunities.
A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Work environment requirements for entry-level opportunities include –
Physical: Computer keyboarding
Auditory/visual: Hearing, vision and talking
Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $63,404 - $85,000/yr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Always accepting applications.

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

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.