Experienced Hybrid Workers' Compensation Claims Examiner

Sedgwick; West Des Moines (IA); Hybrid; USD 60.000 - 84.000; Vollzeit

Benefits dieser Stelle

Flexible schedule

Referral incentives

Career development

Comprehensive benefits

Zusammenfassung

Sedgwick is seeking a Workers Compensation Claims Examiner in the Midwest to analyze and adjudicate complex workers’ compensation claims for our valued clients. The hybrid role requires collaboration with in-house experts and adherence to service expectations.

You will negotiate settlements, calculate reserves, file state documents, and coordinate with vendors. The ideal candidate has five years of claims management experience, a Bachelor’s degree, and strong communication, analytical, and

Qualifikationen

• Five (5) years of claims management experience or equivalent combination of education and experience required.
• Bachelor’s degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Aufgaben

• 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 claims 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.

Kenntnisse

Insurance principles

Communication skills

Microsoft Office

Analytical skills

Organizational skills

Negotiation skills

Team player

Service-oriented

Ausbildung

Bachelor’s degree

Professional certification (preferred)

Tools

Microsoft Office

Jobbeschreibung

Sedgwick is seeking a Workers Compensation Claims Examiner in the Midwest to analyze and adjudicate complex workers’ compensation claims for our valued clients. The hybrid role requires collaboration with in-house experts and adherence to service expectations.

You will negotiate settlements, calculate reserves, file state documents, and coordinate with vendors. The ideal candidate has five years of claims management experience, a Bachelor’s degree, and strong communication, analytical, and