Claims Examiner - Workers Compensation (REMOTE - Needs SE state Exp FL, GA, NC, SC, TN, AL)

Sedgwick Claims Management Services Ltd; Alabama; Remote; USD 50,000 - 90,000; Full time

Job summary

An established industry player is seeking a Claims Examiner to join their dedicated team. This remote role focuses on analyzing complex workers' compensation claims and managing high exposure cases. You'll negotiate settlements, ensure timely resolution, and coordinate vendor referrals, all while maintaining a commitment to quality and service excellence. Join a company recognized for its caring culture and work-life balance, where your contributions make a meaningful impact on individuals facing unexpected challenges. This is a fantastic opportunity for those passionate about claims management and looking to grow their careers in a supportive environment.

Qualifications

• Minimum five years of claims management experience or equivalent.
• Bachelor's degree preferred; professional certifications are a plus.

Responsibilities

• Analyze and process complex claims by investigating and gathering information.
• Negotiate settlements within authority limits.
• Manage litigation process for cost-effective resolution.

Skills

Insurance principles

Claims management

Negotiation skills

Analytical skills

Communication skills

Microsoft Office proficiency

Education

Bachelor's degree

Professional certifications

Job description

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Claims Examiner - Workers Compensation (REMOTE - Needs SE state Exp FL, GA, NC, SC, TN, AL) page is loaded

Claims Examiner - Workers Compensation (REMOTE - Needs SE state Exp FL, GA, NC, SC, TN, AL)

Apply locations: Telecommuter FL, AL, LA, MO, NC

Posted on: Posted Today

Requisition ID: R60141

Join Sedgwick and be part of a meaningful mission. Our 33,000 colleagues serve people facing the unexpected. Grow your career, experience our caring culture, and enjoy work-life balance. There’s no limit to what you can achieve here.

Recognitions include:

• Newsweek’s America’s Greatest Workplaces
• Great Place to Work certification
• Fortune’s Best Workplaces in Financial Services & Insurance

PRIMARY PURPOSE

To analyze complex workers' compensation claims, determine benefits, manage high exposure claims involving litigation and rehabilitation, ensure adjudication within service expectations, and identify subrogation opportunities and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Analyze and process complex claims by investigating and gathering information; manage claims to timely resolution.
• Negotiate settlements within authority limits.
• Calculate and assign reserves, manage reserve adequacy.
• Calculate and pay benefits, approve claim payments and adjustments.
• Prepare state filings within statutory limits.
• Manage litigation process for cost-effective resolution.
• Coordinate vendor referrals for investigation or litigation.
• Apply cost containment techniques including vendor partnerships.
• Manage claim recoveries such as subrogation and offsets.
• Report claims to excess carriers and respond to directions promptly.
• Communicate with claimants and clients professionally.
• Ensure proper documentation and coding of claim files.
• Refer cases to supervisors as needed.

ADDITIONAL FUNCTIONS

• Perform other duties as assigned.
• Support quality programs.
• Travel as required.

QUALIFICATIONS

Education & Licensing

Bachelor's degree preferred; professional certifications are a plus.

Experience

Minimum five years of claims management experience or equivalent.

Skills & Knowledge

• Expertise in insurance principles, laws, recoveries, offsets, claim and disability management, and social security procedures.
• Excellent communication, analytical, organizational, negotiation skills.
• Proficiency in Microsoft Office.
• Ability to work in a team and meet service expectations.

WORK ENVIRONMENT

Accommodations will be considered. The role involves mental, physical, and auditory/visual demands as described.

The statements are general and subject to change at management's discretion.

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

Note

If your experience doesn't perfectly match every qualification, consider applying anyway. Sedgwick values diversity, equity, and inclusion, and each candidate's unique skills and experiences are appreciated.