Claims Examiner at Sedgwick analyzing complex workers compensation claims and ensuring accurate processing. Collaborating with various parties to achieve timely resolution and adherence to standards.
Responsibilities
Analyzes and processes complex or technically difficult claims by investigating and gathering information.
Manages claims through well-developed action plans to an appropriate and timely resolution.
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.
Participates in claim recoveries including subrogation and Social Security offsets.
Communicates claim action/processing with appropriate parties.
Requirements
Bachelor's degree from an accredited college or university preferred.
Licenses as required.
Professional certification as applicable to line-of-business preferred.
Four (4) years claims management experience or equivalent combination of education and experience required.
In-depth line-of-business knowledge of appropriate insurance principles and laws.
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.
Benefits
Three Medical and two dental plans to choose from.
Tuition reimbursement eligible.
401K plan that matches 50% on every $ you put in up to the first 6% you save.
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