Workers Compensation Claims Examiner | Jurisdictions: NJ, PA, VA, MA | Dedicated Client | Capped Caseloads

Sedgwick Claims Management Services Inc.; United States; À distance; USD 80 000 - 85 000; Plein temps

Avantages offerts par ce poste

Flexible work schedule

Referral incentive program

Career development opportunities

Medical, dental, vision, 401K on day 1

Résumé du poste

Sedgwick Claims Management Services Ltd. is seeking a qualified Claims Examiner to analyze Medical Only and Lost-Time workers' compensation claims for our clients. You will determine benefits due and adjudicate claims within service expectations and client requirements.

The role requires 2+ years of claims management experience, strong negotiation skills, and the ability to communicate effectively with claimants and clients. A flexible work environment and comprehensive benefits are provided.

Qualifications

• Education & Licensing: High School Diploma or GED required. Bachelor's degree preferred.
• Experience: 2+ years of claims management experience.
• Jurisdiction Knowledge: NJ, PA, VA, MA.

Responsabilités

• Analyzing and processing medical only & lost-time workers' compensation claims to determine benefits.
• Negotiating settlements within designated authority.
• Communicating claim activity with the claimant and client.
• Reporting claims to the excess carrier and responding to directions timely.

Connaissances

Claims management

Negotiation

Communication

Analytical thinking

Formation

High School Diploma or GED

Bachelor's degree preferred

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 | Jurisdictions: NJ, PA, VA, MA | Dedicated Client | Capped Caseloads

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.

PRIMARY PURPOSE OF THE ROLE

To analyze Medical Only & 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.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• 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.

QUALIFICATIONS

Education & Licensing: High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience: 2+ years of claims management experience or equivalent combination of education and experience required.

Jurisdiction Knowledge: NJ, PA, VA, MA. Licensing: None.

TAKING CARE OF YOU

Flexible work schedule. Referral incentive program. 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.

Auditory/Visual: Hearing, vision and talking.

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 (80 - 85K). 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.

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

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