Workers Compensation Claims Examiner I NY license required I Remote

Lensa; Miami (FL); Remote; USD 56,000 - 80,000; Full time

Job summary

A leading company is seeking a Workers Compensation Claims Examiner I to analyze complex claims and ensure timely resolution. The role involves negotiation, managing litigation, and maintaining professional relationships with clients. This position offers a supportive work environment with opportunities for growth.

Qualifications

• Minimum five years of claims management or equivalent experience.

Responsibilities

• Analyze and process complex workers' compensation claims.
• Negotiate claim settlements within authority limits.
• Manage litigation processes for timely resolution.

Skills

Negotiation

Communication

Organization

Teamwork

Education

Bachelor's degree

Job description

Workers Compensation Claims Examiner I NY license required I Remote

2 days ago Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, Sedgwick, is seeking professionals. Apply via Lensa today!

By joining Sedgwick, you'll be part of a company that makes a meaningful difference. Our 33,000 colleagues serve people worldwide facing unexpected challenges. Grow your career with us, experience our caring culture, and enjoy work-life balance. There’s no limit to what you can achieve.

Recognitions include:

• Newsweek’s America’s Greatest Workplaces
• Certified as a Great Place to Work
• Fortune’s Best Workplaces in Financial Services & Insurance

PRIMARY PURPOSE: To analyze complex workers' compensation claims, determine benefits, handle high exposure claims involving litigation and rehabilitation, ensure claims are adjudicated within service expectations and client requirements, and identify subrogation opportunities and negotiate settlements.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Analyze and process complex workers' compensation claims, investigate, gather information, and manage claims to resolution.
• Negotiate claim settlements within authority limits.
• Calculate and assign reserves; manage reserve adequacy throughout the claim lifecycle.
• Calculate and pay benefits, approve and make timely payments, and settle claims within authority.
• Prepare necessary state filings within statutory limits.
• Manage litigation processes, ensuring timely and cost-effective resolution.
• Coordinate vendor referrals for investigation or 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 and respond to requests promptly.
• Communicate claim activity with claimants and clients, maintaining professional relationships.
• Ensure proper documentation and coding of claim files.
• Refer cases to supervisors 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: Minimum five years of claims management or equivalent.

Skills & Knowledge: Expertise in insurance principles, recoveries, claim and disability management, negotiation, communication, organization, and teamwork skills.

Work Environment: Accommodations considered; includes mental, physical, and sensory requirements.

Salary range for this role in the specified jurisdiction is $56,909 - $79,672, with a comprehensive benefits package offered.

Sedgwick is an Equal Opportunity Employer and Drug-Free Workplace. We welcome candidates with diverse backgrounds and experiences.