Workers Compensation Claims Examiner | Jurisdiction: Midwest | Licensing Required: TX or IN (Hybrid)

Sedgwick Claims Management Services Ltd; Omaha (NE); Hybride; USD 60 000 - 84 000; Plein temps

Avantages offerts par ce poste

Flexible schedule

Referral program

Agile environment

Career development

Benefits package

Résumé du poste

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.

Responsabilités

• 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.

Connaissances

Insurance principles

Communication

Negotiation skills

Analytical skills

Microsoft Office

Organizational skills

Teamwork

Formation

Bachelor's degree

Outils

Microsoft Office

Description du poste

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

Workers Compensation Claims Examiner | Jurisdiction: Midwest | Licensing Required: TX or IN (Hybrid)

Workers Compensation Claims Examiner

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? 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.

ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

WORK LOCATIONS

Hybrid Role - 2 days in office Office located in Omaha, NE or West Des Moines, IA

PRIMARY PURPOSE OF THE ROLE

To analyze 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.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process; ensures timely and cost effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

QUALIFICATION

• Education & Licensing Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.
• Experience Five (5) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

• Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations

TAKING CARE OF YOU

• Flexible work schedule.
• Referral incentive program.
• Opportunity to work in an agile environment.
• Career development and promotional growth opportunities.
• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

WORK ENVIRONMENT REQUIREMENTS INCLUDE

• When applicable and appropriate, consideration will be given to reasonable accommodations.
• Mental:Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
• Physical:Computer keyboarding, [travel as required (leave travel statement only if applicable)]
• Auditory/Visual: Hearing, vision and talking

NOTE

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($60-84,000k). 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 #hybrid

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

Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall.

With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

For more, see sedgwick.com