Claims Representative role in training for workers' compensation at Sedgwick. Involves investigation and resolution of claims with ongoing professional development.
About the role
- WC Claims Examiner analyzing complex and technically difficult workers' compensation claims at Sedgwick. Ensuring claims resolution and negotiating settlements while managing litigation processes.
Responsibilities
- 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
- Identify subrogation of claims and negotiate settlements
- 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
- Prepare necessary state fillings 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
Requirements
- Bachelor's degree from an accredited college or university preferred
- 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
- PC literate, including Microsoft Office products
- Excellent oral and written communication, including presentation skills
- Analytical and interpretive skills
- Strong organizational skills
- Good interpersonal skills
- Excellent negotiation skills
- Ability to work in a team environment
- Ability to meet or exceed Service Expectations
Benefits
- Health insurance
- 401(k) retirement plans
- Paid time off
- Flexible work arrangements
- Professional development opportunities
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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