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Company

Sedgwick · 7 hours ago

Claims Examiner

Tennessee, United States

Full-time

Remote

Mid Level

$41K/yr - $65K/yr

4+ years exp

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H1B Sponsor Likely

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Responsibilities

Analyzes and processes complex or technically difficult claims by investigating and gathering information to assist employer in determining their position on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

Works to move claim towards appropriate claim closure which may include referral for settlement evaluation.

Monitors reserve adequacy throughout the life of the claim if applicable.

Monitors and reviews benefits due and payment calculations ensuring accuracy.

Prepares necessary state filings within statutory limits.

Follows best practice standards in contested claims including outside legal representation.

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.

Participates in claim recoveries including, but not limited to: subrogation, Second Injury Fund recoveries, and Social Security offsets.

Communicates claim action/processing with appropriate parties including, but not limited to: claimant, client, state agency, managed care organization and appropriate medical contact.

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

Maintains professional client relationships.

Coordinates actuarial/settlement issues impacting employers with rate and settlement departments.

Assesses policy level status of clients; works in coordination with clients' service expectations and assigned service personnel.

Performs other duties as assigned.

Supports the organization's quality program(s).

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Claims management experienceInsurance principles knowledgeCost containment principlesPC literateTeamwork ability

Required

Four (4) years claims management experience or equivalent combination of education and experience

In-depth line-of-business knowledge of appropriate insurance principles and laws, recoveries offsets and deductions, and cost containment principles

Excellent oral and written communication skills, including presentation skills

PC literate, including Microsoft Office products

Analytical and interpretive skills

Strong organizational skills

Good interpersonal skills

Ability to work in a team environment

Ability to meet or exceed Performance Competencies

Preferred

Bachelor's degree from an accredited college or university

Professional certification as applicable to line-of-business

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

10001+ 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)