Workers Compensation Claims Examiner | Jurisdiction: Midwest | Licensing Required: TX or IN (Hybrid)
About The Position
The Workers Compensation Claims Examiner analyzes claims on behalf of clients to determine benefits due and ensures claims are adjudicated within service expectations, industry best practices, and client requirements. This hybrid role is based in Omaha, Nebraska, or West Des Moines, Iowa, and requires two days in the office. The examiner manages complex or technically difficult workers’ compensation claims from investigation through resolution, including settlement negotiations, reserves, benefit payments, state filings, litigation, vendor coordination, cost containment, and recoveries. The ideal candidate demonstrates Sedgwick’s values of empathy, accountability, collaboration, growth, and inclusion. The role calls for claims-management expertise, sound judgment and analytical skills, strong communication and negotiation abilities, organization, and the ability to work collaboratively and meet service expectations.
Requirements
- Five years of claims management experience, or an equivalent combination of education and experience.
- Subject-matter expertise in applicable insurance principles and laws, 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 the line of business.
- Excellent oral and written communication skills, 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.
- Workers’ compensation 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
- Investigate and gather information to assess claim exposure, then manage complex or technically difficult workers’ compensation claims through action plans to timely and appropriate resolution.
- Negotiate claim settlements within designated authority.
- Calculate and assign timely, appropriate reserves and manage reserve adequacy throughout the life of each claim.
- 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 to support timely and 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 beginning on day one.
- 401(k) and matching.
- Paid time off (PTO).
- Disability and life insurance.
- Employee assistance program.
- Flexible spending or health savings account.
- Additional voluntary benefits.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
