Hybrid Workers Compensation Claims Examiner

Posted last week

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About the role

  • Analyze complex workers' compensation claims to determine benefits due and manage settlements. Join Sedgwick, a global leader in risk and claims administration, focusing on high-quality customer service.

Responsibilities

  • To analyze complex or technically difficult workers' compensation claims to determine benefits due
  • To work with high exposure claims involving litigation and rehabilitation
  • To ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements
  • To identify subrogation of claims and negotiate settlements
  • Manages claims through well-developed action plans to an appropriate and timely resolution
  • Negotiates settlement of claims within designated authority
  • Calculates and assigns timely and appropriate reserves to claims
  • Approves and makes timely claim payments and adjustments; and settles claims within designated authority level
  • Prepares necessary state fillings within statutory limits
  • Manages the litigation process; ensures timely and cost effective claims resolution

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
  • Excellent oral and written communication, including presentation skills
  • PC literate, including Microsoft Office products
  • 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

  • medical, dental, vision
  • 401k and matching
  • PTO
  • disability and life insurance
  • employee assistance
  • flexible spending or health savings account

Job title

Workers Compensation Claims Examiner

Job type

Experience level

Mid levelSenior

Salary

$80,000 - $98,000 per year

Degree requirement

Bachelor's Degree

Location requirements

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