Claims Examiner - Workers Comp

Sedgwick•Telecommuter OH, OH

20h•$73,000 - $75,000•Remote

About The Position

This role requires the candidate to reside in the state of Ohio. Additionally, applicants must have experience handling or supporting workers' compensation claims, including familiarity with claims processes, documentation, and guidelines. The primary purpose of this role is 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. We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.

Requirements

Four (4) years claims management experience or equivalent combination of education and experience required.
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
Reside in the state of Ohio.
Experience handling or supporting workers' compensation claims, including familiarity with claims processes, documentation, and guidelines.

Nice To Haves

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

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