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're looking for a Workers' Compensation Consultant to analyse complex workers' compensation claims, determine benefits due, and ensure ongoing adjudication of claims within service expectations and industry best practices.
Primary Purpose: Analyse 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:
- Analyse and process complex 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 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 for directions in a professional and timely manner.
- Communicate claim activity and processing with the claimant and client; maintain professional client relationships.
- Ensure claim files are properly documented and claims coding is correct.
- Refer cases as appropriate to supervisor and management.
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.
- Five 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.
What We Offer:
- Competitive salary range: $65,000 - $80,000 CAD annually.
- Comprehensive benefits package.