Claims Examiner - Workers Compensation

Sedgwick • Raleigh, NC

21h

About The Position

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. Sedgwick has been recognized as America’s Greatest Workplaces, National Top Companies Certified as a Great Place to Work®, and Fortune Best Workplaces in Financial Services & Insurance. This role offers 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. You will apply your knowledge and experience to adjudicate complex customer claims in an energetic culture, delivering innovative customer-facing solutions to clients across virtually every industry. Be part of a rapidly growing, industry-leading global company known for its excellence and customer service. You can leverage Sedgwick’s broad, global network of experts to both learn from and share your insights, and take advantage of a variety of professional development opportunities to grow your career. The position offers flexibility and autonomy in daily work, location, and career path, along with diverse and comprehensive benefits for mental, physical, financial, and professional needs. The primary purpose of this role is to analyze complex or technically difficult workers' compensation claims to determine benefits due, work with high exposure claims involving litigation and rehabilitation, ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements, and identify subrogation of claims and negotiate settlements. We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

Requirements

• Five (5) years of claims management experience or equivalent combination of education and experience required.
• Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
• Excellent oral and written communication, including presentation skills.
• PC literate, including Microsoft Office products.
• Analytical and interpretive skills.
• Strong organizational skills.
• Good interpersonal skills.
• Excellent negotiation skills.
• Ability to work in a team environment.
• Ability to meet or exceed Service Expectations.

Nice To Haves

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

Responsibilities

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process; ensures timely and cost effective claims resolution.
• 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.
• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Travels as required.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed
• Number of Employees: 251-500 employees