STD Claims Examiner II making accurate claim decisions for Short Term Disability claims. Collaborating with team members in a hybrid work environment from South Portland, ME.
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
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