Description
By joining Sedgwick, you'll be part of a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands. As a Workers Compensation Claims Examiner, you will analyze complex or technically difficult workers' compensation claims to determine benefits due, work with high exposure claims involving litigation and rehabilitation, and ensure 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
- 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 clients
- Manage claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets
- Report claims to the excess carrier; respond to requests of directions in a professional and timely manner
- Communicate claim activity and processing with the claimant and the client; maintain professional client relationships
- Ensure claim files are properly documented and claims coding is correct
- Refer cases as appropriate to supervisor and management
Qualifications:
- 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
- California jurisdictional knowledge required; SIP required or must be obtained within one (1) year of employment
Benefits:
- Flexible work schedule
- Referral incentive program
- Career development and promotional growth opportunities
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one
Salary: 80,000 - 100,000 per year