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Claims Examiner - Workers Compensation

Role overview

Qualifications

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

Responsibilities

  • Analyze and process Workers Compensation claims to determine benefits due
  • Negotiate settlement of claims within designated authority
  • Communicate claim activity and processing with the claimant and the client
  • Report claims to the excess carrier and respond to requests in a professional and timely manner

Key facts

Other skills

  • Negotiation
  • Problem Solving
  • Decision Making
  • Report Writing
  • Investigation
  • Empathy
  • Accountability
  • Collaboration
  • Troubleshooting (Problem Solving)
  • Stress Management
  • Time Management

About the company

EFI Global logo

EFI Global

Engineering Services

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
IndustryEngineering Services
Company size501 - 1000

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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

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?   

  • Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.  

​ 

ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.  

PRIMARY PURPOSE OF THE ROLE 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: 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. 

Experience: 5 years of claims management experience or equivalent combination of education and experience required. 

TAKING CARE OF YOU  

  • Flexible work schedule.  

  • Referral incentive program.  

  • Career development and promotional growth opportunities.  

  • A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. 

WORK ENVIRONMENT REQUIREMENTS INCLUDE  
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 

#claimsexaminer #claims #hybrid #LI-REMOTE #Texas #Texasjobs

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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