Sedgwick - Dallas, TX

posted about 2 months ago

Full-time - Mid Level
Remote - Dallas, TX
10,001+ employees
Insurance Carriers and Related Activities

About the position

The Claims Examiner for Workers Compensation at Sedgwick is responsible for analyzing mid- and higher-level workers compensation claims to determine benefits due, ensuring claims are adjudicated according to company standards and industry best practices. This role involves managing claims, negotiating settlements, and maintaining professional relationships with clients and claimants, all while contributing to a culture of caring and support within the organization.

Responsibilities

  • Analyze mid- and higher-level workers compensation claims to determine benefits due.
  • Manage workers compensation claims determining compensability and benefits due on long-term indemnity claims.
  • Monitor reserve accuracy and file necessary documentation with state agencies.
  • Develop and manage action plans for claims resolution and coordinate return-to-work efforts.
  • Approve and process assigned claims, determining benefits due and managing action plans.
  • Manage subrogation of claims and negotiate settlements.
  • Communicate claim actions with claimants and clients.
  • Ensure claim files are properly documented and claims coding is correct.
  • Process complex lifetime medical and/or defined period medical claims as needed.
  • Maintain professional client relationships.

Requirements

  • 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 procedures as applicable to the line of business.
  • Excellent oral and written communication skills, including presentation skills.
  • PC literate, including Microsoft Office products.
  • Strong analytical and interpretive skills.
  • Strong organizational skills and good interpersonal skills.
  • Excellent negotiation skills.
  • Ability to work in a team environment.
  • Ability to meet or exceed service expectations.

Benefits

  • Flexible work environment
  • Support for mental, physical, financial, and professional needs
  • Opportunities for career growth and skill sharpening
  • Diversity and inclusion initiatives
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