Description
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.
The primary purpose of this role is to analyse mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.
Responsibilities:
- Manage workers compensation claims determining compensability and benefits due on long-term indemnity claims, monitor reserve accuracy, and file necessary documentation with state agencies.
- Develop and manage workers compensation claims' action plans to resolution, coordinate return-to-work efforts, and approve claim payments.
- Approve and process assigned claims, determine benefits due, and manage action plans pursuant to the claim or client contract.
- Manage subrogation of claims and negotiate settlements.
- Communicate claim actions with claimants and clients.
- Ensure claim files are properly documented and claims coding is accurate.
- May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilisation review.
- Maintain professional client relationships.
Additional Functions and Responsibilities:
- Perform other duties as assigned.
- Support the organisation's quality program(s).
- Travel as required.
Requirements:
- Bachelor's degree from an accredited college or university preferred.
- Four (4) years of claims management experience or equivalent combination of education and experience required.
- Working knowledge of regulations, offsets and deductions, disability duration, medical management practices, and Social Security and Medicare application procedures as applicable to the 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.
What We Offer:
- Salary Range: $55,000 – $60,000 CAD annually
- Full-time, salaried position
- Compensation is determined based on experience, qualifications, and internal equity.