Claims Examiner - Workers Compensation - Telecommute OR

National African-American Insurance Association (NAAIA); Oregon (WI); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading insurance provider is seeking a remote Claims Examiner to analyze complex workers' compensation claims and ensure timely resolution. Candidates should have at least five years of claims management experience, ideally inclusive of litigation cases. The role offers a flexible work schedule and promotes a diverse and inclusive workplace, making it ideal for those looking to grow their careers in a supportive environment.

Benefits

Flexible Work Schedule

Referral Incentive Program

Opportunity to work from home

Career development and promotional growth opportunities

Comprehensive benefits offering including medical, dental, vision, 401K on day 1

Qualifications

• Five years of claims management experience or equivalent combination of education and experience.
• Experience in managing high exposure claims involving litigation and negotiation.

Responsibilities

• Analyze complex workers' compensation claims and determine benefits due.
• Negotiate settlement of claims within designated authority.
• Manage litigation process and claims resolution.

Skills

Claims Management

Negotiation

Communication

Analytical Skills

Education

Bachelor's degree from an accredited college or university

Professional certification in applicable line of business

Job description

Overview

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.

Position

Claims Examiner - Workers Compensation - Telecommute OR

Are you an ideal candidate?

We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

Primary purpose of the role

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 responsibilities may include:

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process; ensures timely and cost-effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
• Ensures claim files are properly documented, and claims coding is correct.
• Refers cases as appropriate to supervisor and management.
• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

Qualifications & Licensing

Education & Experience

Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience

Five (5) years of claims management experience or equivalent combination of education and experience required.

Taking care of you

• Flexible Work Schedule
• Referral Incentive Program
• Opportunity to work from home
• Career development and promotional growth opportunities
• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day 1

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

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.