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Sedgwick · 1 month ago

Claim Examiner - Workers Compensation | Jurisdiction OK and LA | TX Licensing

Plano, TX

Full-time

Hybrid

Mid Level

Sedgwick is a global industry leader that offers meaningful career opportunities in a supportive work environment. The Claim Examiner role involves analyzing and processing complex workers' compensation claims, negotiating settlements, and managing claims through effective action plans to ensure timely resolution.

BankingInsuranceRisk Management

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

Workers Compensation ClaimsClaims ManagementNegotiation SkillsOklahoma Jurisdiction KnowledgeLouisiana Jurisdiction KnowledgeTexas LicensingProfessional CertificationsBachelor's DegreeEmpathyAccountabilityInclusionCommunication SkillsCollaborationGrowth Mindset