Claims Examiner - Workers Compensation | Dedicated Client

Sedgwick; Oregon; Hybrid; USD 85,000 - 105,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development and promotions

Medical, dental, vision, 401K on day 1

Job summary

Sedgwick is seeking a Claims Examiner – Workers' Compensation to analyze and adjudicate claims for clients. You will determine benefits due, adhere to service expectations, and leverage best practices.

The role emphasizes collaboration with clients and carriers to resolve claims efficiently. The position requires 3+ years in claims management, a high school credential, and preferred California jurisdiction knowledge; flexibility around work schedule and a strong commitment to professional

Qualifications

• 3 years of claims management experience or equivalent education/experience.
• High School Diploma or GED required; Bachelor’s degree preferred.
• Professional certification relevant to line of business preferred.

Responsibilities

• Analyze and process workers compensation claims to determine benefits due and adjudicate within service expectations.
• Negotiate settlements within designated authority.
• Communicate claim activity with claimant and client.
• Notify claims to excess carrier and respond to directions promptly.

Skills

Claims management

Negotiation

Client and claimant communication

Analytical thinking

Education

High School Diploma or GED

Bachelor’s degree preferred

Professional certification (licensing)

Job description

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 | Dedicated Client. Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands?

PRIMARY PURPOSE OF THE ROLE:

To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

QUALIFICATIONS

• Eduction & Licensing: 3 years of claims management experience or equivalent combination of education and experience required.
• High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.

Licensing / Jurisdiction Knowledge: 3 or more years California workers compensation jurisdictional knowledge required, SIP required or must be obtained within one (1) year of employment.

TAKING CARE OF YOU

• Flexible work schedule.
• Referral incentive program.
• Career development and promotional growth opportunities.
• Diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

WORK ENVIRONMENT REQUIREMENTS INCLUDE

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. 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 $85-105K.

BENEFITS

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

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.