Sedgwick is looking for a Claims Examiner specializing in Workers Compensation to join our team. In this role, you will analyze complex and technically difficult claims to determine benefits due, working with high exposure cases involving litigation and rehabilitation. You will ensure ongoing adjudication aligns with service expectations, 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 appropriate and timely resolution.
- Negotiate settlement of claims within designated authority.
- Calculate and assign timely and appropriate reserves to claims, managing reserve adequacy throughout the claim lifecycle.
- 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.
- Support the organization's quality program(s).
- Travel as required.
What We're Looking For
- Five (5) years of Workers Compensation claims management 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.
- A diverse and comprehensive benefits offering including medical, dental, vision, 401K on day one.
Work Mode
This is a remote role open to candidates with relevant experience in the states of Florida (FL) and Tennessee (TN).
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
