# Workers Compensation Claims Examiner **Company**: Sedgwick **Location**: Omaha, NE **Work arrangement**: hybrid **Experience**: senior **Job type**: full-time **Salary**: $60-84,000 **Category**: Insurance **Industry**: Insurance **Apply**: https://sedgwick.wd1.myworkdayjobs.com/en-US/Sedgwick/job/Omaha-NE/Workers-Compensation-Claims-Examiner---Jurisdiction--Midwest---Licensing-Required--TX-or-IN--Hybrid-_R79635?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply **Canonical**: https://yubhub.co/jobs/job_436e2e33-751 ## 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. We're looking for a Workers Compensation Claims Examiner to join our team in a hybrid role, working 2 days in office. As a Workers Compensation Claims Examiner, you will analyze claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. **Responsibilities:** - Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manage claims through well-developed action plans to an appropriate and timely resolution. - Negotiate settlement of claims within designated authority. - Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim. - Calculate and pay benefits due; approve and make timely claim payments and adjustments; and settle claims within designated authority level. - Prepare necessary state filings within statutory limits. - Manage the litigation process; ensure timely and cost-effective claims resolution. - Coordinate vendor referrals for additional investigation and/or litigation management. - Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. - Manage 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 organizational skills. - Good interpersonal skills. - Excellent negotiation skills. - Ability to work in a team environment. - Ability to meet or exceed Service Expectations. **Benefits:** - Flexible work schedule. - Referral incentive program. - Opportunity to work in an agile environment. - Career development and promotional growth opportunities. - A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. **Work Environment Requirements:** - Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem-solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. - Physical: Computer keyboarding. - Auditory/Visual: Hearing, vision and talking. ## Skills ### Required - insurance principles - laws for line-of-business - claims management - Microsoft Office products - analytical skills - organizational skills - interpersonal skills - negotiation skills ### Nice to have - professional certification - subject matter expert --- Source: [Apply at sedgwick.wd1.myworkdayjobs.com](https://sedgwick.wd1.myworkdayjobs.com/en-US/Sedgwick/job/Omaha-NE/Workers-Compensation-Claims-Examiner---Jurisdiction--Midwest---Licensing-Required--TX-or-IN--Hybrid-_R79635?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)