Sedgwick is seeking a Claims Examiner - Workers Compensation to analyze complex or technically difficult claims and determine benefits due. You'll manage high-exposure claims involving litigation and rehabilitation, ensuring ongoing adjudication aligns with industry best practices and specific client requirements.
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 designated authority.
- Calculate and assign timely and appropriate reserves; 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 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, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
What We're Looking For
- 3-4 years of Workers Compensation claims management experience or an equivalent combination of education and experience.
Nice to Have
- Bachelor's degree from an accredited college or university.
Benefits & Compensation
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- Comprehensive benefits including medical, dental, vision, and 401K starting on day one.
Work Mode
This role is remote and requires experience handling workers' compensation claims in Florida, Georgia, Alabama, or Tennessee.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
