Workers Compensation Claims Examiner | Jurisdictions: NJ, PA, VA, MA | Dedicated Client | Capped Caseloads

Sedgwick•Telecommuter NJ, NJ

5d•$80,000 - $85,000•Remote

About The Position

The Workers Compensation Claims Examiner analyzes Medical Only and Lost-Time Workers Compensation claims on behalf of clients to determine benefits due. The role ensures ongoing claim adjudication meets service expectations, industry best practices, and client-specific service requirements. The examiner investigates and gathers information, develops action plans, negotiates settlements within designated authority, communicates claim activity to claimants and clients, and reports claims to excess carriers. The position covers the jurisdictions of New Jersey, Pennsylvania, Virginia, and Massachusetts and has no licensing requirement.

Requirements

High school diploma or GED.
At least 2 years of claims management experience or an equivalent combination of education and experience.
Jurisdiction knowledge covering NJ, PA, VA, and MA.
Ability to think clearly and conceptually; exercise judgment, troubleshoot, solve problems, analyze information, and use discretion.
Ability to handle work-related stress, manage multiple priorities simultaneously, and meet deadlines.
Computer keyboarding ability, and hearing, vision, and talking abilities.

Nice To Haves

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

Responsibilities

Analyze and process claims through well-developed action plans toward appropriate and timely resolution.
Investigate and gather information to determine claim exposure.
Negotiate claim settlements within designated authority.
Communicate claim activity and processing with claimants and clients.
Report claims to excess carriers and respond professionally and promptly to requests for direction.