Claims Examiner - Workers Compensation | Jurisdiction: TX, OK, & LA | Licensing: TX/FL preferre[...]

Sedgwick; Plano (TX); On-site; USD 50,000 - 70,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Comprehensive benefits offering

Job summary

A leading claims management company is looking for a Claims Examiner in Plano, TX. The role involves analyzing complex workers' compensation claims and negotiating settlements. Candidates should possess a Bachelor's degree and ideally five years of claims management experience. This position offers a flexible work schedule and career growth opportunities, with the expectation of working hybrid if located within 25 miles of a company office.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Five (5) years of claims management experience required.
• Licenses as required, preferably TX, OK, or LA.

Responsibilities

• Analyzes and processes complex workers' compensation claims.
• Negotiates settlement of claims within designated authority.
• Communicates claim activity with claimants and clients.

Skills

Claims analysis

Negotiation

Communication

Problem-solving

Education

Bachelor's degree

Job description

Overview

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 | Jurisdiction: TX, OK, & LA | Licensing: TX/FL preferred (Plano,TX/Remote)

Are you an ideal candidate?

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.

Office location

The selected candidate will be expected to work a hybrid schedule if within 25 miles of a Sedgwick office, if outside of this radius it will be work from home.

Primary purpose of the role

We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

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 claims within designated authority level.
• Prepares necessary state filings 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.
• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

Qualifications

Education and Licensing
Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certifications as applicable to line of business preferred.

Experience
Five (5) years of claims management experience or equivalent combination of education and experience required.

Jurisdiction
TX, OK and LA

Licensing
TX, OK or LA preferred

Taking care of you

Flexible work schedule.

Referral incentive program.

Opportunity to work in an agile environment.

Career development and promotional growth opportunities.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

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.