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. In this remote role, you will analyze complex claims, negotiate settlements, and ensure compliance with industry standards. Ideal candidates will have a Bachelor's degree and five years of claims management experience. Enjoy a supportive work environment that values diversity and inclusion.

Qualifications

• Five years claims management or equivalent experience required.

Responsibilities

• Analyze and process complex workers' compensation claims.
• Negotiate settlements within authority limits.
• Manage litigation processes for timely resolution.

Skills

Communication

Negotiation

Analytical Skills

Interpersonal Skills

Organizational Skills

Education

Bachelor's degree

Tools

Microsoft Office

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 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.

Recognitions include:

• Newsweek America's Greatest Workplaces Top Companies
• Great Place to Work Certified
• Fortune Best Workplaces in Financial Services & Insurance

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

PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; work with high exposure claims involving litigation and rehabilitation; ensure ongoing adjudication of claims within service expectations, industry best practices, and client requirements; identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

1. Analyze and process complex workers' compensation claims by investigating and gathering information to determine exposure; manage claims through action plans to resolution.
2. Negotiate settlements within authority limits.
3. Assign and manage reserves throughout the claim's lifecycle.
4. Calculate and pay benefits, approve adjustments, and settle claims within authority.
5. Prepare state filings within statutory limits.
6. Manage litigation processes for timely and cost-effective resolution.
7. Coordinate vendor referrals for investigations and litigation management.
8. Use cost containment techniques including vendor partnerships to reduce claim costs.
9. Manage claim recoveries like subrogation and offsets.
10. Report claims to excess carriers and respond to directions professionally.
11. Communicate claim activity with claimants and clients, maintaining professional relationships.
12. Ensure proper documentation and coding of claim files.
13. Refer cases to supervisors as appropriate.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

1. Perform other duties as assigned.
2. Support quality programs.
3. Travel as required.

QUALIFICATIONS

Education & Licensing

Bachelor's degree preferred; professional certification as applicable.

Experience

Five (5) years claims management or equivalent experience required.

Skills & Knowledge

• Expertise in insurance principles, recoveries, claim duration, cost containment, medical management, and applicable social security procedures.
• Excellent communication, presentation, organizational, negotiation, and interpersonal skills.
• Proficiency in Microsoft Office.
• Analytical and interpretive skills.
• Ability to work in a team and meet service expectations.

WORK ENVIRONMENT

Reasonable accommodations will be considered.

Mental:

Clear thinking, judgment, troubleshooting, problem solving, stress management, multitasking, and meeting deadlines.

Physical:

Computer use, travel.

Auditory/Visual:

Hearing, vision, talking.

Note: Credit security clearance via background check required.

The statements describe the general nature of work and are not exhaustive. Management may change duties at any time.

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

If your experience doesn't align perfectly, consider applying anyway! Sedgwick values diversity, equity, and inclusion, and each person’s unique skills and experiences may make you the right fit for this or other roles.