Be an early applicantLess than 25 applicants

Company

Sedgwick · 7 hours ago

Claims Examiner Workers Compensation

California, United States

Full-time

Remote

Mid, Senior Level

$65K/yr - $100K/yr

5+ years exp

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Responsibilities

Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

Negotiates settlement of claims within designated authority.

Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

Prepares necessary state fillings within statutory limits.

Manages the litigation process; ensures timely and cost effective claims resolution.

Coordinates vendor referrals for additional investigation and/or litigation management.

Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.

Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.

Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.

Ensures claim files are properly documented and claims coding is correct.

Refers cases as appropriate to supervisor and management.

Performs other duties as assigned.

Supports the organization's quality program(s).

Travels as required.

Qualification

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Claims management experienceInsurance principlesMicrosoft OfficeService expectationsTeamwork ability

Required

Five (5) years of claims management experience or equivalent combination of education and experience required.

Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.

Excellent oral and written communication, including presentation skills

PC literate, including Microsoft Office products

Analytical and interpretive skills

Strong organizational skills

Good interpersonal skills

Excellent negotiation skills

Ability to work in a team environment

Ability to meet or exceed Service Expectations

Preferred

Bachelor's degree from an accredited college or university preferred.

Professional certification as applicable to line of business preferred.

Benefits

Medical

Dental

Vision

401k and matching

PTO

Disability and life insurance

Employee assistance

Flexible spending or health savings account

Other additional voluntary benefits

Company

Sedgwick

Glassdoor

3.3

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions.

Founded in 1969

Memphis, Tennessee, USA

10,001+ employees

http://www.sedgwick.com

H1B Sponsorship

Sedgwick has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2023 (3)

2022 (9)

2021 (14)

2020 (9)