Claims Examiner - Workers Compensation | Dedicated Support
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. 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 Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career? A stable and consistent work environment in an office setting PRIMARY PURPOSE OF THE ROLE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
Requirements
- 5 years of claims management experience or equivalent combination of education and experience required.
- High School Diploma or GED required.
- Computer keyboarding, travel as required
- 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
- Hearing, vision and talking
Nice To Haves
- Bachelor's degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
Responsibilities
- Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
- Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.
- Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
- Administers subrogation of claims and negotiates settlements.
- Communicates claim action with claimant and client.
- Ensures claim files are properly documented and claims coding is correct.
- May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
- Maintains professional client relationships.
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.
- medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
