Workers Compensation Claims Examiner I NY license required I Remote

Lensa; New York (NY); Remote; USD 56,000 - 80,000; Full time

Job summary

A leading company is seeking a Workers Compensation Claims Examiner I with a NY license for a remote position. The role involves analyzing complex claims, negotiating settlements, and ensuring compliance with regulations. Ideal candidates possess strong analytical and negotiation skills, with a background in insurance principles and claims management. Join a supportive team that values work-life balance and offers competitive compensation and benefits.

Benefits

Medical insurance

Dental insurance

Vision insurance

401k

PTO

Qualifications

• 5 years claims management or equivalent experience required.

Responsibilities

• Analyze and process complex workers' compensation claims.
• Negotiate settlement of claims within authority limits.
• Manage litigation process for timely resolution.

Skills

Insurance principles

Analytical skills

Negotiation

Communication

Teamwork

Education

Bachelor's degree

Job description

Workers Compensation Claims Examiner I NY license required I Remote

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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 something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world 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 Overview

Primary Purpose: 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 requirements; and to identify subrogation of claims and negotiate settlements.

Essential Functions and Responsibilities

• Analyze and process complex workers' compensation claims by investigating and gathering information to determine exposure; manage claims through action plans for timely resolution.
• Negotiate settlement of claims within authority limits.
• Calculate and assign reserves to claims; manage reserve adequacy throughout the claim's lifecycle.
• Calculate and pay benefits; approve and make timely payments and adjustments; settle claims within authority.
• Prepare necessary state filings within statutory limits.
• Manage litigation process to ensure timely and cost-effective resolution.
• Coordinate vendor referrals for investigation and 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 needed.

Additional Functions

• Perform other duties as assigned.
• Support quality programs.
• Travel as required.

Qualifications

Education & Licensing: Bachelor's degree preferred; professional certification as applicable.

Experience: 5 years claims management or equivalent.

Skills & Knowledge: Insurance principles, law, recoveries, cost containment, medical management, social security, Medicare, communication, PC literacy, analytical skills, organization, negotiation, teamwork, service orientation.

Work Environment

Includes considerations for mental, physical, and auditory/visual aspects; accommodations available as needed.

Compensation range for NY: $56,909 - $79,672. Benefits include medical, dental, vision, 401k, PTO, insurance, and more.

Sedgwick is an Equal Opportunity Employer and Drug-Free Workplace. We encourage diverse applications and value unique skills and experiences.