Sedgwick is looking for a Claims Examiner - Workers Compensation to analyze complex and technically difficult claims, ensuring adjudication aligns with service expectations and best practices. You will focus on claims with high exposure involving litigation and rehabilitation.
What You'll Do
- Analyze and process complex workers' compensation claims by investigating and gathering information to determine exposure.
- Manage claims through well-developed action plans to achieve appropriate and timely resolution.
- Negotiate settlement of claims within designated authority.
- Calculate and assign timely reserves; manage reserve adequacy throughout the claim lifecycle.
- Calculate and pay benefits due; approve timely claim payments and adjustments.
- Prepare necessary state filings within statutory limits.
- Manage the litigation process to ensure timely and cost-effective claims resolution.
- Coordinate vendor referrals for additional investigation or litigation management.
- Use cost containment techniques, including strategic vendor partnerships.
- Manage claim recoveries, including subrogation, Second Injury Fund recoveries, and offsets.
- Report claims to excess carriers and respond professionally to requests.
- Communicate claim activity with claimants and clients; maintain professional relationships.
- Ensure claim files are properly documented and coded correctly.
- Refer cases as appropriate to supervisor and management.
- Support the organization's quality programs.
- Travel as required.
What We're Looking For
- Five (5) years of claims management experience or an equivalent combination of education and experience.
Nice to Have
- Bachelor's degree from an accredited college or university.
- Professional certifications applicable to the line of business.
- Licensing in TX, OK, or LA; TX or FL licensure is preferred.
Benefits & Compensation
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental, vision, and 401K on day one.
Work Mode
This role offers a hybrid work arrangement based in Plano, TX.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
