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Workers Compensation Claims Examiner | NY Jurisdiction | NY Licensing | Remote

Role overview

Qualifications

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

Responsibilities

  • Analyze Workers' Compensation Lost-Time claims to determine benefits due and adjudicate within service expectations and client requirements
  • Negotiate settlements within designated authority
  • Communicate claim activity with claimants and clients
  • Report claims to the excess carrier and respond to directions in a professional and timely manner

About the company

Sedgwick Ireland logo

Sedgwick Ireland

Sedgwick, previously operating under the OSG Vericlaim brand, is Ireland's largest and longest established Specialist Third Party Administrator and Loss Adjuster. We are a SEDGWICK Company and part of the Global Sedgwick Organisation backed by the resources of the Leading Global Provider of technology enabled risk and claims solutions we can truly offer a local market based service operating to market leading international standards. Having built on our history and heritage as Chartered Loss Adjusters, today we provide a diverse and extensive range of outsource services for the Insurance and Financial Sectors in Ireland and Internationally. A unique business model incorporating industry and market experience, the application of behavioural science, lean process management and modern technology sets Sedgwick apart from the competition in our chosen markets. Providing the service layer between our clients and their customers we have a proven pedigree and reputation for operational excellence delivering the widest range of specialist and technical services in the market. The Sedgwick difference is our People and a desire to develop our talent for the benefit of all our stakeholders. Taking Care of People "Caring Counts” is at the heart of everything we do and the guiding principal in the development of Sedgwick becoming the leading broad based service provider we are today. We are Regulated as an Insurance Intermediary with the Central Bank of Ireland, have full EU Passport status and meet all Fiduciary and Corporate Governance Standards.

Company details

Company typeStartup
Industry
Company size201 - 500

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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

Workers Compensation Claims Examiner | NY Jurisdiction | NY Licensing | 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 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. 

ARE YOU AN IDEAL CANDIDATE? To analyze Workers Compensation Lost-Time 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.

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.

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: 4+ 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.

Jurisdiction Knowledge: NY

Licensing: NY

TAKING CARE OF YOU

  • Flexible work schedule. 
  • Referral incentive program. 
  • Opportunity to work in an agile environment. [IF APPLICABLE] 
  • 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 (75,000 -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.

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.

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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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