Sedgwick is looking for a Claims Examiner specializing in Workers' Compensation to join our team. You will analyze complex or technically difficult claims to determine benefits due, managing high exposure cases involving litigation and rehabilitation. This role is essential to ensuring ongoing adjudication of claims within service expectations and industry best practices.

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 an appropriate and timely resolution.
Negotiate settlement of claims within your 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.
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 and litigation management.
Use appropriate cost containment techniques including strategic vendor partnerships.
Manage claim recoveries, including subrogation and offsets.
Report claims to the excess carrier and respond to requests professionally.
Communicate claim activity with the claimant and client to maintain professional relationships.
Ensure claim files are properly documented and claims coding is correct.
Refer cases as appropriate to supervisor and management.
Support the organization's quality program(s).
Travel as required.