Workers Compensation Consultant - Level 3

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

As a Workers Compensation Consultant - Level 3, you will play a critical role in analysing complex or technically difficult workers' compensation claims to determine benefits due. You 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. You will also identify subrogation of claims and negotiate settlements.

Key responsibilities include:

• Analysing and processing complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim
• Managing claims through well-developed action plans to an appropriate and timely resolution with CNESST
• Negotiating settlement of claims within designated authority
• Calculating and assigning timely and appropriate reserves to claims; managing reserve adequacy throughout the life of the claim
• Calculating and paying benefits due; approving and making timely claim payments and adjustments; and settling claims within designated authority level
• Preparing necessary state filings within statutory limits
• Managing the litigation process; ensuring timely and cost-effective claims resolution
• Coordinating vendor referrals for additional investigation and/or litigation management
• Using appropriate cost containment techniques, including strategic vendor partnerships, to reduce overall cost of claims for our clients
• Managing claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets

Requirements:

• Bachelor's degree from an accredited college or university preferred
• Professional certification as applicable to line of business preferred
• Five (5) years of claims management experience or equivalent combination of education and experience required
• Subject matter expert of appropriate insurance principles and laws for 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 to line-of-business
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organisational skills
• Good interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations
• Extensive knowledge of CNESST
• Must be bilingual (French and English) if seeking position in Quebec

Benefits:

• Competitive salary
• Caring culture
• Work-life balance

Sedgwick uses artificial intelligence tools to assist in the screening, assessment, or selection of candidates. These tools are subject to periodic review. We are committed to inclusive, barrier-free recruitment and selection processes. If contacted for an employment opportunity, please advise Colleague Resources if you require accommodation.