Claims Examiner - Workers Compensation | REMOTE - NEED OR/WA JURISDICTIONAL KNOWLEDGE

Sedgwick-posted about 1 year ago
$63,000 - $90,000/Yr
Full-time • Mid Level
Remote • Portland, OR
Insurance Carriers and Related Activities
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The Claims Examiner - Workers Compensation position at Sedgwick involves analyzing complex workers' compensation claims to determine benefits due, managing high exposure claims, and ensuring compliance with service expectations and industry best practices. The role requires jurisdictional knowledge of Oregon and Washington claims, with a focus on negotiation, litigation management, and effective communication with clients and claimants.

  • Analyze and process complex workers' compensation claims by investigating and gathering information.
  • Manage claims through well-developed action plans to timely resolution.
  • Negotiate settlement of claims within designated authority.
  • Calculate and assign timely and appropriate reserves to claims.
  • Approve and make timely claim payments and adjustments.
  • Prepare necessary state filings within statutory limits.
  • Manage the litigation process for timely and cost-effective claims resolution.
  • Coordinate vendor referrals for additional investigation and/or litigation management.
  • Utilize cost containment techniques to reduce overall claims costs.
  • Manage claim recoveries including subrogation and offsets.
  • Report claims to the excess carrier and respond to requests professionally.
  • Communicate claim activity and processing with claimants and clients.
  • Ensure proper documentation and coding of claim files.
  • Bachelor's degree from an accredited college or university preferred.
  • Five (5) years of claims management experience or equivalent combination of education and experience required.
  • Subject matter expert in insurance principles and laws relevant to the line of business.
  • Excellent oral and written communication skills, including presentation skills.
  • PC literate, including proficiency in Microsoft Office products.
  • Strong analytical and interpretive skills.
  • Good organizational and interpersonal skills.
  • Excellent negotiation skills.
  • Ability to work in a team environment and meet service expectations.
  • Professional certification as applicable to line of business preferred.
  • Medical insurance
  • Dental insurance
  • Vision insurance
  • 401k and matching
  • Paid Time Off (PTO)
  • Disability insurance
  • Life insurance
  • Employee assistance programs
  • Flexible spending or health savings account
  • Additional voluntary benefits
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