Claims Examiner - Workers Compensation (REMOTE w/NC, SC, AL exp)

Sedgwick; United States; Remote; USD 60,000 - 85,000; Full time

Job summary

Join a leading company as a Claims Examiner for Workers Compensation, where you'll analyze complex claims, negotiate settlements, and ensure compliance with industry standards. This remote position offers a chance to grow your career in a supportive environment with a focus on work-life balance.

Qualifications

• Five years of claims management or equivalent experience.
• Bachelor's degree preferred; professional certifications are a plus.
• Expert knowledge of insurance principles and claim management.

Responsibilities

• Analyze and process complex workers' compensation claims.
• Negotiate settlement of claims within authority limits.
• Manage litigation processes and ensure timely resolution.

Skills

Analytical skills

Negotiation skills

Communication skills

Organizational skills

Team player

Education

Bachelor's degree

Job description

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

Claims Examiner - Workers Compensation (REMOTE w/NC, SC, AL exp)

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 the exposure; manage claims through action plans to resolution.
• Negotiate settlement of claims within authority limits.
• Calculate and assign reserves; manage reserve adequacy throughout the claim's life.
• Calculate and pay benefits; approve and make timely payments and adjustments; settle claims within authority.
• Prepare necessary state filings within statutory limits.
• Manage litigation processes; ensure 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, including subrogation and offsets.
• Report claims to excess carriers; respond to requests professionally and timely.
• Communicate claim activity with claimants and clients; maintain professional relationships.
• Ensure proper documentation and coding of claim files.
• Refer cases to supervisors and management 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 certifications are a plus.

Experience: Five years of claims management or equivalent.

Skills & Knowledge: Expert knowledge of insurance principles, laws, recoveries, claim management, and cost containment; excellent communication, analytical, organizational, negotiation skills; team player; able to meet service expectations.

WORK ENVIRONMENT

Consideration for reasonable accommodations; mental, physical, auditory/visual requirements as described; credit security clearance required.

The statements are intended to describe the general nature of work; management may modify duties as needed.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If your experience doesn't match all qualifications, consider applying anyway. Sedgwick values diverse, equitable, and inclusive workplaces, recognizing each person's unique skills, knowledge, and experience.