Claims Examiner - Workers Compensation
Posted on: June 20, 2022
The 'Apply with SEEK' option will be utilized for International
applicants, mainly Australia. If this does not apply to you please
use the 'Apply' option. Claims Examiner - Workers Compensation IF
YOU CARE, THERE'S A PLACE FOR YOU HEREFor a career path that is
both challenging and rewarding, join Sedgwick's talented team of
27,000 colleagues around the globe. Sedgwick is a leading provider
of technology-enabled risk, benefits and integrated business
solutions. Taking care of people is at the heart of everything we
do. Millions of people and organizations count on Sedgwick each
year to take care of their needs when they face a major life event
or something unexpected happens. Whether they have a workplace
injury, suffer property or financial loss or damage from a natural
or manmade disaster, are involved in an auto or other type of
accident, or need time away from work for the birth of a child or
another medical situation, we are here to provide compassionate
care and expert guidance. Our clients depend on our talented
colleagues to take care of their most valuable assets-their
employees, their customers and their property. At Sedgwick, caring
counts -. Join our team of creative and caring people of all
backgrounds, and help us make a difference in the lives of others.
For more than 50 years, Sedgwick has been helping employers answer
virtually every question there is about workers' compensation. We
have experience in nearly every type of industry and region and
provide the industry's broadest range of programs and services.
PRIMARY PURPOSE: -To analyze complex or technically difficult
workers' compensation claims to determine benefits due; to work
with high exposure claims involving litigation and rehabilitation;
to ensure ongoing adjudication of claims within service
expectations, industry best practices and specific client service
requirements; and to identify subrogation of claims and negotiate
settlements.ESSENTIAL FUNCTIONS and 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
- Negotiates settlement of claims within designated
- Calculates and assigns timely and appropriate reserves to
claims; manages reserve adequacy throughout the life of the
- Calculates and pays benefits due; approves and makes timely
claim payments and adjustments; and settles clams within designated
- 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
- 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
- Refers cases as appropriate to supervisor and
management.ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travels as required.QUALIFICATIONEducation &
LicensingBachelor's -degree from an accredited college or
university preferred. Professional certification as applicable to
line of business preferred.ExperienceFive (5) years of claims
management experience or equivalent combination of education and
experience required.Skills & Knowledge
- 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
- Excellent oral and written communication, including
- 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 ExpectationsWORK
ENVIRONMENTWhen applicable and appropriate, consideration will be
given to reasonable accommodations. -Mental: -Clear and conceptual
thinking ability; excellent judgment, troubleshooting, problem
solving, analysis, and discretion; ability to handle work-related
stress; ability to handle multiple priorities simultaneously; and
ability to meet deadlinesPhysical: -Computer keyboarding, travel as
requiredAuditory/Visual: -Hearing, vision and talkingNOTE: Credit
security clearance, confirmed via a background credit check, is
required for this position.The statements contained in this
document are intended to describe the general nature and level of
work being performed by a colleague assigned to this description.
-They are not intended to constitute a comprehensive list of
functions, duties, or local variances. -Management retains the
discretion to add or to change the duties of the position at any
time.#L1-TS1 Sedgwick -is an Equal Opportunity Employer and a
Keywords: Sedgwick, Fullerton , Claims Examiner - Workers Compensation, Other , Brea, California
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