Hybrid Workers' Compensation Claims Examiner

Sedgwick Claims Management Services Ltd; Omaha (NE); Hybrid; USD 60,000 - 84,000; Full time

Benefits offered by this job

Flexible schedule

Referral program

Agile environment

Career development

Benefits package

Job summary

Sedgwick is seeking a Workers Compensation Claims Examiner to join its Midwest team. You will analyze complex workers’ compensation claims to determine benefits due, and adjudicate within service standards and client requirements.

This hybrid role requires strong negotiation, reserve management, and coordination with vendors. A bachelor’s degree and five years of claims experience are preferred, with licensing considerations noted for TX or IN.

Qualifications

• Bachelor's degree preferred.
• Five years of claims management experience or equivalent.
• Professional certification as applicable to line of business preferred.

Responsibilities

• Analyze and process complex workers' compensation claims to determine exposure and resolve claims.
• Negotiate settlements within designated authority.
• Calculate reserves and manage reserve adequacy.
• Authorize and pay benefits, and settle claims within authority.
• Prepare necessary state filings within statutory limits.
• Manage the litigation process; coordinate referrals for investigation/litigation.
• Use cost containment techniques including vendor partnerships to reduce costs.
• Manage claim recoveries including subrogation and offsets.

Skills

Insurance principles

Communication

Negotiation skills

Analytical skills

Microsoft Office

Organizational skills

Teamwork

Education

Bachelor's degree

Tools

Microsoft Office

Job description

Sedgwick is seeking a Workers Compensation Claims Examiner to join its Midwest team. You will analyze complex workers’ compensation claims to determine benefits due, and adjudicate within service standards and client requirements.

This hybrid role requires strong negotiation, reserve management, and coordination with vendors. A bachelor’s degree and five years of claims experience are preferred, with licensing considerations noted for TX or IN.