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

Lensa; Overland Park (KS); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company is seeking a Claims Examiner specializing in Workers' Compensation for a remote role in the Southeast. Responsibilities include analyzing claims, negotiating settlements, and managing litigation. Ideal candidates will have strong communication and negotiation skills, along with a solid background in claims management.

Qualifications

• Minimum of five years claims management experience or equivalent.
• Knowledge of insurance principles, laws, and claims processes.

Responsibilities

• Analyze and process complex workers' compensation claims.
• Negotiate claim settlements within authority limits.
• Manage reserves, benefits payments, and claim adjustments.

Skills

Communication

Negotiation

Organizational

Analytical

Education

Bachelor's degree

Job description

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

Join Sedgwick as a Claims Examiner specializing in Workers' Compensation, working remotely in the Southeast region. This role involves analyzing complex claims, negotiating settlements, managing litigation, and ensuring compliance with industry standards.

Primary Responsibilities:

• Analyze and process complex workers' compensation claims, investigating and determining exposure.
• Negotiate claim settlements within authority limits.
• Manage reserves, benefits payments, and claim adjustments timely and accurately.
• Coordinate litigation and vendor referrals for investigations or legal management.
• Utilize cost containment strategies and manage claim recoveries including subrogation and offsets.
• Maintain professional communication with claimants and clients, ensuring proper documentation and claims coding.

Qualifications:

• Bachelor's degree preferred; professional certification is a plus.
• Minimum of five years claims management experience or equivalent.
• Knowledge of insurance principles, laws, and claims processes.
• Strong communication, negotiation, organizational, and analytical skills.

Work Environment & Additional Info:

This position requires handling multiple priorities, working under stress, and possibly traveling. A background check and credit clearance are required. Sedgwick is committed to diversity and equal opportunity employment.