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 Orange, CA. As a global industry leader, we need someone who can bring their big ideas to help solve problems for some of the world's best brands.
Primary Purpose: Analyze complex or technically difficult workers' compensation claims to determine benefits due; work with high exposure claims involving litigation and rehabilitation; ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and identify subrogation of claims and negotiate settlements.
Essential Functions and 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.
- 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:
- 5 years of claims management experience or equivalent combination of education and experience required.
- High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
- California workers' compensation claims handling experience; SIP certified preferred.
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.
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.
The salary range for this role is $80,000 - $105,000 per year.