Claims Examiner - Workers Compensation | Central Jurisdiction job opportunity at Sedgwick.

Home Jobs In United States Of America Tag: Job Claims Examiner - Workers Compensation | Central Jurisdiction position at Sedgwick


DateMore Than 30 Days Ago bot
Sedgwick Claims Examiner - Workers Compensation | Central Jurisdiction
Experience: General
Pattern: full-time
Country:
apply Apply Now
Salary:
Status:

Job

Copy Link Report
degreeOND
loacation US Telecommuter, United States Of America
loacation US Telecommute..........United States Of America

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 invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Claims Examiner - Workers Compensation | Central Jurisdiction PRIMARY PURPOSE : 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; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; 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; manages reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level. Prepares necessary state fillings within statutory limits. Manages the litigation process; ensures timely and cost effective claims resolution. Coordinates vendor referrals for additional investigation and/or litigation management. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. Ensures claim files are properly documented and claims coding is correct. Refers cases as appropriate to supervisor and management. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. QUALIFICATIONS Education & Licensing Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Central claims experience - IN, IA, IL MI, KS, MO, MN, and or TX, OK, AR, LA, highly preferred. Experience Five (5) years of claims management experience or equivalent combination of education and experience required. Skills & Knowledge 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 organizational skills Good interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Service Expectations WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations.  Mental:  Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical:  Computer keyboarding, travel as required Auditory/Visual:  Hearing, vision and talking As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $75,000 - $90,000/yr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. #LIRemote #ClaimsExaminer Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Other Ai Matches

Specialty Loss Adjuster Applicants are expected to have a solid experience in handling Job related tasks
Utilization Review Coordinator Applicants are expected to have a solid experience in handling Job related tasks
Asbestdeskundige Applicants are expected to have a solid experience in handling Job related tasks
Building Consultant - Expert Services, Subsidence Applicants are expected to have a solid experience in handling Subsidence related tasks
Senior Loss Adjuster Applicants are expected to have a solid experience in handling Job related tasks
Adjuster Sr Applicants are expected to have a solid experience in handling Job related tasks
Liability Utilities Adjuster Applicants are expected to have a solid experience in handling Job related tasks
Sr. Executive General Adjuster (Remote in California) Applicants are expected to have a solid experience in handling Job related tasks
Per Diem Workers Compensation Adjuster Applicants are expected to have a solid experience in handling Job related tasks
Workers Compensation Claims Examiner | CA Jurisdiction Knowledge Required | Brea, CA Applicants are expected to have a solid experience in handling CA related tasks
FNOL Agent (Motor Team) Applicants are expected to have a solid experience in handling Job related tasks
Domestic Major Loss Adjuster - London, Southeast coast and Kent Applicants are expected to have a solid experience in handling Southeast coast and Kent related tasks
Workers Compensation Claims Examiner | Dedicated Account | Rancho Cordova (3 Days Remote) Applicants are expected to have a solid experience in handling Job related tasks
Claims Examiner l Liability l Jurisdiction Louisiana l Must reside in Louisiana Applicants are expected to have a solid experience in handling Job related tasks
Claims Technician (Fresh Grads are welcome!) Applicants are expected to have a solid experience in handling Job related tasks
Workforce Absence Payroll Coordinator Applicants are expected to have a solid experience in handling Job related tasks
Field Case Manager-Sign-On Bonus Eligible Applicants are expected to have a solid experience in handling Job related tasks
Field Case Manager-Sign-On Bonus Eligible Applicants are expected to have a solid experience in handling Job related tasks
Claims Adjuster Trainee Applicants are expected to have a solid experience in handling Job related tasks
Leave of Absence Coordinator Applicants are expected to have a solid experience in handling Job related tasks
Quality Control Representative - Heavy Equipment/Specialty Applicants are expected to have a solid experience in handling Job related tasks
ADA Accommodation Specialist Applicants are expected to have a solid experience in handling Job related tasks
Marine Surveyor- Toronto Applicants are expected to have a solid experience in handling Job related tasks