Workers Compensation Consultant - Level 2

Sedgwick

11d

About The Position

Sedgwick is seeking Workers' Compensation Consultants. By joining Sedgwick, you will be part of a meaningful organization with 33,000 colleagues globally, dedicated to helping people facing the unexpected. Sedgwick is recognized as one of America’s Greatest Workplaces and a Great Place to Work®. Ideal candidates should have experience handling Workers Compensation claims across Canadian jurisdictions or a background in absence management, leave administration, STD/LTD adjudication. The role requires paralegal expertise, strong knowledge of workers’ compensation legislation and health & safety standards, and proven ability to manage complex claims processes. The primary purpose of this position is to analyze mid- and higher-level workers compensation claims to determine benefits due, ensure ongoing adjudication of claims within company standards and industry best practices, and identify subrogation of claims and negotiate settlements.

Requirements

Experience handling Workers Compensation claims across Canadian jurisdictions—or background in absence management, leave administration, STD/LTD adjudication
Paralegal expertise for handling claims, appeals, and compliance matters
Strong knowledge of workers’ compensation legislation and health & safety standards
Proven ability to manage complex claims processes and collaborate with stakeholders
Experience in HR leave programs, disability case management, and policy interpretation
Four (4) years of claims management experience or equivalent combination of education and experience
Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
Excellent oral and written communication, including presentation skills
PC literate, 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

Nice To Haves

Bachelor's degree from an accredited college or university preferred

Responsibilities

Manages 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 manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts and approves claim payments.
Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
Manages 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 complex 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.
Performs other duties as assigned.
Supports the organization's quality program(s).
Travel as required.