Claims Examiner - Workers Compensation (REMOTE - Southeast State Exp Required)

Lensa; Birmingham (AL); Remote; USD 60,000 - 80,000; Full time

Job summary

Join a leading company as a Claims Examiner specializing in Workers Compensation, working remotely within Southeast states. You will analyze complex claims, negotiate settlements, and manage litigation processes while ensuring compliance with service standards. This role offers opportunities for growth and is ideal for candidates with a strong background in claims management.

Qualifications

• Minimum of 5 years in claims management or equivalent experience.
• Bachelor's degree preferred; professional certifications advantageous.
• Expertise in insurance principles and strong communication skills.

Responsibilities

• Analyze complex workers' compensation claims to determine benefits.
• Negotiate claim settlements and manage litigation processes.
• Ensure claims are processed within service standards.

Skills

Communication

Negotiation

Organizational

Insurance Principles

Education

Bachelor's degree

Professional certifications

Tools

Microsoft Office

Job description

Claims Examiner - Workers Compensation (REMOTE - Southeast State Exp Required)

Join Sedgwick as a Claims Examiner specializing in Workers Compensation, working remotely within Southeast states. Be part of a company recognized for its outstanding workplace culture and commitment to employee growth.

PRIMARY PURPOSE

Analyze complex workers' compensation claims to determine benefits, manage high-exposure claims involving litigation and rehabilitation, and ensure claims are processed within service standards and client requirements. Identify subrogation opportunities and negotiate settlements.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Investigate and process complex claims, managing them through action plans to resolution.
• Negotiate claim settlements within authority limits.
• Assign and manage reserves, ensuring adequacy throughout the claim lifecycle.
• Calculate and disburse benefits, make adjustments, and settle claims timely.
• Prepare necessary filings within statutory limits.
• Manage litigation processes and coordinate investigations or litigation referrals.
• Implement cost containment strategies, including vendor partnerships.
• Manage claim recoveries such as subrogation and offsets.
• Report claims to excess carriers and respond to their requests promptly.
• Communicate with claimants and clients, maintaining professional relationships.
• Ensure proper documentation and coding of claims files.
• Refer complex cases to supervisors as needed.

QUALIFICATIONS

Education & Licensing: Bachelor's degree preferred; professional certifications advantageous.

Experience: Minimum of 5 years in claims management or equivalent.

Skills & Knowledge: Expertise in insurance principles, strong communication, organizational, negotiation skills, and proficiency with Microsoft Office.

WORK ENVIRONMENT

Ability to handle stress, multitask, and meet deadlines. Reasonable accommodations will be considered.

Note: Background credit check required.

Additional Information

Sedgwick is committed to diversity and inclusion. If your experience aligns closely, consider applying even if not all qualifications are met. We offer a dynamic environment with opportunities for growth and impact.