Workers Compensation Claims Examiner | Jurisdiction: Midwest | Licensing Required: TX or IN (Hybrid)

Sedgwick • Omaha, NE

2d • Hybrid

About The Position

The Workers Compensation Claims Examiner analyzes claims on behalf of clients to determine benefits due and ensures claims are adjudicated in line with service expectations, industry best practices, and client requirements. The role investigates and manages complex claims through resolution, negotiates settlements within authority, maintains appropriate reserves, calculates and pays benefits, prepares required state filings, and oversees litigation and recoveries. The position is hybrid, with two days in the office, at the Omaha, Nebraska or West Des Moines, Iowa office.

Requirements

• Five years of claims management experience, or an equivalent combination of education and experience.
• Subject-matter expertise in applicable insurance principles and laws for the 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.
• Excellent oral and written communication, including presentation skills.
• PC literacy, 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.
• Licensing required: Texas or Indiana.

Nice To Haves

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

Responsibilities

• Analyze and process complex or technically difficult workers’ compensation claims by investigating and gathering information to determine claim exposure.
• Manage claims using action plans to achieve appropriate and timely resolution.
• Negotiate claim settlements within designated authority.
• Calculate and assign timely, appropriate reserves and manage reserve adequacy throughout the claim lifecycle.
• Calculate and pay benefits, approve and make timely claim payments and adjustments, and settle claims within designated authority.
• Prepare necessary state filings within statutory limits.
• Manage the litigation process and ensure timely, cost-effective claim resolution.
• Coordinate vendor referrals for additional investigation or litigation management.
• Use cost-containment techniques, including strategic vendor partnerships, to reduce clients’ overall claim costs.
• Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.

Benefits

• Flexible work schedule.
• Referral incentive program.
• Career development and promotional growth opportunities.
• Medical, dental, and vision benefits.
• 401(k) and matching.
• Paid time off (PTO).
• Disability and life insurance.
• Employee assistance program.
• Flexible spending account or health savings account.
• Additional voluntary benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level