Workers Compensation Claims Examiner | Dedicated Client | Jurisdictions: DE, IL,LA, MO, NJ, OK, TN, TX | Licensing: Required | Litigation Experience

Sedgwick; Missouri; Remote; USD 60,000 - 85,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401(k) on day one

Job summary

Sedgwick is seeking a driven Workers’ Compensation Claims Examiner to adjudicate complex claims for diverse clients from a remote-friendly setup in the United States. The role emphasizes timely resolution, adherence to service expectations, and collaboration with clients and claimants.

Ideal candidates will have a High School Diploma or GED (Bachelor’s preferred), 5+ years of claims management experience, and required licensing.

Qualifications

• High School Diploma or GED required.
• Bachelor's degree from an accredited college or university preferred.
• 5 years of claims management experience or equivalent required.
• Licensing: Required.
• Heavy Litigation experience required.

Responsibilities

• Analyze Lost-Time Workers Compensation claims to determine benefits due and adjudicate within service expectations.
• Analyze and process claims through well-developed action plans to timely resolutions.
• Negotiate settlements within designated authority.
• Communicate claim activity and processing with the claimant and the client.
• Report claims to the excess carrier and respond to directions in a professional, timely manner.

Skills

5+ years claims management experience

Claim analysis

Negotiation

Communication with claimant/client

Reporting to carriers

Problem solving

Attention to detail

Education

High School Diploma or GED

Bachelor's degree preferred

Job description

Fortune Best Workplaces in Financial Services & Insurance

Workers Compensation Claims Examiner | Dedicated Client | Jurisdictions: DE, IL, LA, MO, NJ, OK, TN, TX | Licensing: Required | Litigation Experience Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?

• Apply your examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
• Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.
• Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
• Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.
• Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
• Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

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 Lost-Time Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements .

Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.

• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Education & Licensing: High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Experience: 5 years of claims management experience or equivalent combination of education and experience required.

Heavy Litigation - experience required

Flexible work schedule.

• Career development and promotional growth opportunities.
• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

excellent judgment, troubleshooting, problem solving, analysis, and discretion; Computer keyboarding

Auditory/Visual: Hearing, vision and talking

A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

#claimsexaminer #claims #LI-REMOTE

Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.