Claims Examiner - Workers Compensation (REMOTE - Exp in some: TN/AR/MS/KY/AL/GA/FL)

Sedgwick; Town of Florida (NY); Remote; USD 60,000 - 85,000; Full time

Job summary

A leading global claims management company is seeking a Claims Examiner for remote work. Responsibilities include analyzing complex workers' compensation claims, negotiating settlements, and managing claim reserves. Candidates should have at least five years of claims management experience and a Bachelor's degree. A range of benefits is offered including a flexible work schedule and comprehensive health packages.

Benefits

Flexible work schedule

Career development opportunities

Comprehensive benefits offering

Qualifications

• Five years of claims management experience or equivalent.
• Professional certification preferred in relevant states.

Responsibilities

• Analyze complex workers' compensation claims.
• Negotiate settlements within designated authority.
• Calculate and assign appropriate reserves.

Skills

Claims management experience

Negotiation skills

Analytical skills

Empathy

Education

Bachelor's degree

Job description

Claims Examiner - Workers Compensation (REMOTE - Exp in some: TN/AR/MS/KY/AL/GA/FL)

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

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?

• Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
• Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.
• Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
• Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.
• Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
• Enjoy flexibility and autonomy in your daily work, your location, and your career path.
• Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

ARE YOU AN IDEAL CANDIDATE?

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

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

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

QUALIFICATIONS

Education & Licensing

Bachelor'sdegree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience :

Five (5) years of claims management experience or equivalent combination of education and experience required in some of the following states: TN/AR/MS/KY/AL/GA/FL

TAKING CARE OF YOU

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

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.

Sedgwickis 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.