Workers Compensation Claims Examiner I NY license required I Remote

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

Job summary

A leading company in claims administration seeks a Workers Compensation Claims Examiner to analyze complex claims and negotiate settlements. The role requires a bachelor's degree and five years of claims management experience. Join a caring culture that values diversity and offers a comprehensive benefits package.

Qualifications

• Five years of claims management experience or equivalent.
• Professional certification relevant to the line of business preferred.

Responsibilities

• Analyze and process complex workers' compensation claims.
• Negotiate settlement of claims within designated authority.
• Manage the litigation process and coordinate vendor referrals.

Skills

Insurance principles

Negotiation skills

Analytical skills

Communication

Organizational skills

Education

Bachelor's degree from an accredited college or university

Tools

Microsoft Office

Job description

Workers Compensation Claims Examiner I NY license required I Remote

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

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 service requirements; and to identify subrogation of claims and negotiate settlements.

Essential Functions and Responsibilities

• Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manage claims through well-developed action plans to an appropriate and timely resolution.
• Negotiate settlement of claims within designated authority.
• Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
• Calculate and pay benefits due; approve and make timely claim payments and adjustments; settle claims within designated authority level.
• Prepare necessary state filings within statutory limits.
• Manage the litigation process; ensure timely and cost-effective claims resolution.
• Coordinate vendor referrals for additional investigation and/or litigation management.
• Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for clients.
• Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
• Report claims to the excess carrier; respond to requests promptly and professionally.
• Communicate claim activity and processing with claimants and clients; maintain professional relationships.
• Ensure claim files are properly documented and claims coding is correct.
• Refer cases as appropriate to supervisor and management.

Additional Functions and Responsibilities

• Perform other duties as assigned.
• Support the organization's quality programs.
• Travel as required.

Qualifications

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Professional certification relevant to the line of business is preferred.

Experience

Five (5) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

• Subject matter expert in insurance principles, laws, recoveries, offsets, claim and disability duration, cost containment, medical management practices, and applicable Social Security and Medicare procedures.
• Excellent oral and written communication, including presentation skills.
• Proficient in Microsoft Office.
• Analytical, interpretive, and organizational skills.
• Strong interpersonal and negotiation skills.
• Ability to work in a team and meet or exceed service expectations.

Work Environment

Consideration will be given to reasonable accommodations. The environment involves mental, physical, and auditory/visual demands as described.

The statements are intended to describe the general nature and level of work performed; they are not exhaustive. Management may modify duties as needed.

Salary range: ($56,909 - $79,672). A comprehensive benefits package is offered.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If your experience doesn't align perfectly with every qualification, consider applying anyway! We value diversity and unique skills.

Sedgwick helps clients thrive by navigating the unexpected, with expertise and AI-enabled technology. With over 33,000 colleagues and 10,000 clients across 80 countries, we provide solutions in claims administration, loss adjusting, benefits administration, and product recall.