# Claims Examiner- Worker's Compensation **Company**: Sedgwick **Experience**: senior **Job type**: full-time **Category**: Other **Industry**: Insurance **Apply**: https://sedgwick.wd1.myworkdayjobs.com/en-US/Sedgwick/job/Southfield-MI/Claims-Examiner--Worker-s-Compensation_R79136?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply **Canonical**: https://yubhub.co/jobs/job_9f689f54-534 ## 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. As a Claims Examiner - Worker's Compensation, your primary purpose will be to analyze complex or technically difficult workers' compensation claims to determine benefits due. You will 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. **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 - 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 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 **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 ## Skills ### Required - insurance principles - claims management - litigation management - cost containment - Microsoft Office - analytical skills - organisational skills - communication skills - negotiation skills ### Nice to have - professional certification --- Source: [Apply at sedgwick.wd1.myworkdayjobs.com](https://sedgwick.wd1.myworkdayjobs.com/en-US/Sedgwick/job/Southfield-MI/Claims-Examiner--Worker-s-Compensation_R79136?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)