Claims Examiner - Workers Compensation | Dedicated Support

Sedgwick • Chicago, IL

10d • Onsite

About The Position

This role involves analyzing complex or technically difficult workers' compensation claims to determine benefits due. The Claims Examiner will work with high exposure claims involving litigation and rehabilitation, ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. A key aspect of the role is identifying subrogation of claims and negotiating settlements. Sedgwick is looking for driven individuals who embody their caring counts model and core values, including empathy, accountability, collaboration, growth, and inclusion. This position offers an opportunity to develop a professional career in a stable and consistent office environment, with no prior experience required for the initial processing of low-level claims.

Requirements

• 5 years of claims management experience or equivalent combination of education and experience required.
• High School Diploma or GED required.

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.
• Medical, dental vision, 401K on day one.
• PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED