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

Lensa; Houston (TX); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading career site is seeking a Claims Examiner for a remote role focused on workers' compensation claims. The position involves analyzing complex claims, negotiating settlements, and ensuring compliance with industry standards. Ideal candidates will have a Bachelor's degree and five years of relevant experience, along with strong negotiation and communication skills.

Qualifications

• Bachelor's degree preferred; professional certification as applicable.
• Five years of claims management or equivalent experience.

Responsibilities

• Analyze and process complex workers' compensation claims.
• Negotiate settlement of claims within designated authority.
• Manage litigation process and coordinate vendor referrals.

Skills

Insurance principles

Negotiation

Communication

Organizational skills

Teamwork

Education

Bachelor's degree

Job description

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

1 day ago - Be among the first 25 applicants

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

Lensa is the leading career site for job seekers at every stage of their career. Our client, Sedgwick, is seeking professionals. Apply via Lensa today!

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

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 workers' compensation claims by investigating and gathering information to determine exposure; manage claims through well-developed action plans to resolution.
• Negotiate settlement of claims within designated authority.
• Calculate and assign appropriate reserves; manage reserve adequacy throughout the claim's life.
• Calculate and pay benefits, approve and make timely claim payments and adjustments, and settle claims within authority level.
• Prepare necessary state filings within statutory limits.
• Manage litigation process, ensuring timely and cost-effective resolution.
• Coordinate vendor referrals for investigation and litigation management.
• Use cost containment techniques including vendor partnerships to reduce overall claim costs.
• Manage claim recoveries such as subrogation, excess recoveries, and offsets.
• Report claims to excess carriers and respond to requests promptly.
• Communicate claim activity with claimants and clients, maintaining professional relationships.
• Ensure claim files are properly documented and coded.
• Refer cases to supervisors as appropriate.

Additional Functions and Responsibilities

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

Qualifications

Education & Licensing: Bachelor's degree preferred; professional certification as applicable.

Experience: Five years of claims management or equivalent.

Skills & Knowledge: Insurance principles, recoveries, claim and disability management, negotiation, communication, organizational skills, and ability to work in a team.

Work Environment

Consideration for reasonable accommodations. Requires mental clarity, good judgment, stress management, multi-tasking, and meeting deadlines. Physical requirements include computer use and travel. Hearing, vision, and talking abilities are necessary.

Note: Credit security clearance via background check required.

Additional Information

Statements are general; duties may change. Sedgwick is an Equal Opportunity Employer and Drug-Free Workplace. If your experience doesn’t match all qualifications, consider applying anyway. Sedgwick is a global leader in risk and claims management, leveraging advanced AI technology. For more info, visit sedgwick.com.