Sedgwick · 5 days ago
Workers Compensation Claims Examiner
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BankingInsurance
Insider Connection @Sedgwick
Responsibilities
Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
Manages subrogation of claims and negotiates settlements.
Communicates claim action with claimant and client.
Ensures claim files are properly documented and claims coding is correct.
May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
Maintains professional client relationships.
Qualification
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Required
Bachelor's degree from an accredited college or university preferred.
Four (4) years of claims management experience or equivalent combination of education and experience required.
Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure 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 skill
Good interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Service Expectations
Benefits
Flexible work schedule
Referral incentive program
Career development and promotional growth opportunities
Medical, dental, vision
401K on day one
PTO
Disability and life insurance
Employee assistance
Flexible spending or health savings account
Other additional voluntary benefits
Company
Sedgwick
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions.
Funding
Current Stage
Late StageTotal Funding
$501.78MKey Investors
Caisse de Depot et Placement du Quebec
2018-12-01Private Equity· Undisclosed
2018-09-12Acquired· by The Carlyle Group ($6.7B)
2016-09-28Private Equity· $500M
Recent News
2024-03-04
2024-01-22
2023-12-04
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