Sedgwick is seeking a Claims Examiner - Workers Compensation to analyze complex and technically difficult claims. In this role, you will determine benefits due on high exposure claims involving litigation and rehabilitation, ensuring adjudication aligns with service expectations and industry best practices.
What You'll Do
- Analyze and process complex workers' compensation claims by investigating and gathering information to determine claim exposure.
- Manage claims through well-developed action plans to achieve appropriate and timely resolution.
- Negotiate and settle claims within designated authority.
- Calculate and assign timely, appropriate reserves and manage 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 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.
- A diverse and comprehensive benefits offering including medical, dental, vision, and 401K on day one.
Work Mode
This is a remote position. Candidates must reside in and have experience with claims in North Carolina, South Carolina, Virginia, or New Hampshire.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
