Claims Examiner - Workers Compensation (REMOTE - Need AL GA NC SC MS KY exp)

Sedgwick; Atlanta (GA); Remote; USD 60,000 - 80,000; Full time

Job summary

Join a leading company as a Claims Examiner for Workers Compensation, where you'll analyze complex claims and ensure timely resolutions. This remote role requires expertise in insurance principles and excellent communication skills. Enjoy a supportive work environment and opportunities for growth.

Qualifications

• Five years of claims management experience required.
• Professional certification preferred.

Responsibilities

• Analyze and process complex workers' compensation claims.
• Negotiate settlement of claims within authority.
• Manage litigation process and ensure timely resolution.

Skills

Insurance Principles

Communication

Analytical Skills

Negotiation Skills

Education

Bachelor's Degree

Tools

Microsoft Office

Job description

Claims Examiner - Workers Compensation (REMOTE - Need AL GA NC SC MS KY exp)

Join to apply for the Claims Examiner - Workers Compensation (REMOTE - Need AL GA NC SC MS KY exp) role at Sedgwick.

Get AI-powered advice on this job and more exclusive features.

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 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.

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

• Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manage claims through well-developed action plans to an appropriate and timely resolution.
• Negotiate settlement of claims within designated authority.
• Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
• Calculate and pay benefits due; approve and make timely claim payments and adjustments; settle claims within designated authority level.
• Prepare necessary state filings within statutory limits.
• Manage the litigation process; ensure timely and cost-effective claims resolution.
• Coordinate vendor referrals for additional investigation and/or litigation management.
• Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for clients.
• Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
• Report claims to the excess carrier; respond to requests of directions professionally and timely.
• Communicate claim activity and processing with the claimant and the client; maintain professional client relationships.
• Ensure claim files are properly documented and claims coding is correct.
• Refer cases as appropriate to supervisor and management.

ADDITIONAL FUNCTIONS AND RESPONSIBILITIES

• Perform other duties as assigned.
• Support the organization's quality programs.
• Travel as required.

QUALIFICATIONS

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to the line of business is preferred.

Experience

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

Skills & Knowledge

• Subject matter expert of insurance principles, laws, recoveries, offsets, claim and disability duration, cost containment, medical management, and Social Security/Medicare procedures as applicable.
• Excellent oral and written communication and presentation skills.
• Proficient in Microsoft Office products.
• Analytical, interpretive, and organizational skills.
• Interpersonal and negotiation skills.
• Ability to work in a team and meet or exceed service expectations.

WORK ENVIRONMENT

Consideration for reasonable accommodations will be given. The environment includes mental, physical, and auditory/visual aspects as described.

Note: Credit security clearance via background credit check is required.

The statements are not exhaustive; management may modify duties at any time. Sedgwick is an Equal Opportunity Employer and Drug-Free Workplace.

If your experience doesn't align perfectly with every qualification, consider applying anyway! Sedgwick values diversity and unique skills.