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

Lensa; Miami (FL); Remote; USD 60,000 - 80,000; Full time

Job summary

Join a leading risk management company as a Claims Examiner, where you'll analyze complex workers' compensation claims, negotiate settlements, and manage high exposure claims. This remote role requires expertise in insurance principles and excellent communication skills. Enjoy a supportive work environment and opportunities for growth.

Qualifications

• Minimum of five years claims management experience or equivalent.
• Professional certifications relevant to the line of business are preferred.

Responsibilities

• Investigate and process complex workers' compensation claims.
• Negotiate claim settlements within authority limits.
• Manage litigation processes to ensure timely resolutions.

Skills

Communication

Negotiation

Analytical Skills

Interpersonal Skills

Education

Bachelor's degree

Tools

Microsoft Office

Job description

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

2 days ago Be among the first 25 applicants

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 a meaningful team dedicated to helping people facing unexpected challenges. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. There’s no limit to what you can achieve.

Recognition and accolades include:

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

PRIMARY PURPOSE

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

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Investigate and process complex workers' compensation claims, managing them through well-developed action plans to timely resolution.
• Negotiate claim settlements within authority limits.
• Calculate and assign reserves, managing reserve adequacy throughout the claim's lifecycle.
• Calculate and pay benefits, approve claim payments and adjustments, and settle claims within authority.
• Prepare state filings within statutory limits.
• Manage litigation processes to ensure timely and cost-effective resolutions.
• Coordinate vendor referrals for investigations or litigation management.
• Utilize cost containment techniques, including vendor partnerships, to reduce claim costs.
• Manage recoveries such as subrogation, Second Injury Fund, and offsets for Social Security and Medicare.
• Report claims to excess carriers and respond to requests professionally and promptly.
• Communicate claim activities with claimants and clients, maintaining professional relationships.
• Ensure proper documentation and coding of claim files.
• Refer cases as appropriate to supervisors and management.

ADDITIONAL FUNCTIONS

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

QUALIFICATIONS

Education & Licensing

Bachelor's degree preferred; professional certifications relevant to the line of business are also preferred.

Experience

Minimum of five years claims management experience or equivalent.

Skills & Knowledge

• Expertise in insurance principles, laws, recoveries, offsets, claim and disability management, and cost containment.
• Excellent communication, presentation, organizational, interpersonal, and negotiation skills.
• Proficiency in Microsoft Office and analytical skills.
• Ability to work effectively in a team and meet service expectations.

WORK ENVIRONMENT

Accommodation considerations will be made where applicable.

Physical, mental, auditory/visual requirements include computer use, travel, hearing, vision, and talking.

A background credit check is required for security clearance.

The statements are not exhaustive; management may modify duties as needed.

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

If your experience doesn't match every qualification, consider applying anyway. Sedgwick values diversity and the unique skills each person brings.

Sedgwick is a global leader in risk and claims management, leveraging advanced AI technology, with over 33,000 colleagues and 10,000 clients worldwide. For more, visit sedgwick.com.