Workers’ Compensation Claims Representative at West Bend, guiding injured employees through the recovery process and ensuring fair claim resolution. Opportunity to lead with confidence in problem - solving and negotiation.
About the role
- Claims Examiner at Sedgwick analyzing complex workers compensation claims and ensuring accurate processing. Collaborating with various parties to achieve timely resolution and adherence to standards.
Responsibilities
- Analyzes and processes complex or technically difficult claims by investigating and gathering information.
- Manages claims through well-developed action plans to an appropriate and timely resolution.
- Monitors reserve adequacy throughout the life of the claim if applicable.
- Monitors and reviews benefits due and payment calculations ensuring accuracy.
- Prepares necessary state filings within statutory limits.
- Follows best practice standards in contested claims including outside legal representation.
- Coordinates vendor referrals for additional investigation and/or litigation management.
- Uses appropriate cost containment techniques including strategic vendor partnerships.
- Participates in claim recoveries including subrogation and Social Security offsets.
- Communicates claim action/processing with appropriate parties.
Requirements
- Bachelor's degree from an accredited college or university preferred.
- Licenses as required.
- Professional certification as applicable to line-of-business preferred.
- Four (4) years claims management experience or equivalent combination of education and experience required.
- In-depth line-of-business knowledge of appropriate insurance principles and laws.
- Excellent oral and written communication skills, including presentation skills.
- PC literate, including Microsoft Office products.
- Analytical and interpretive skills.
- Strong organizational skills.
- Good interpersonal skills.
- Ability to work in a team environment.
Benefits
- Three Medical and two dental plans to choose from.
- Tuition reimbursement eligible.
- 401K plan that matches 50% on every $ you put in up to the first 6% you save.
- 4 weeks PTO your first full year.
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