Field Claims Adjuster in a hybrid role at ClaimsPro supporting claims in Prince Albert area. Actively adjusting claims and ensuring business development opportunities are maximized.
About the role
- Analyzing and processing complex workers' compensation claims for Sedgwick, a global industry leader. Delivering customer-facing solutions in a caring culture with professional development opportunities.
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 resolution.
- Negotiates settlement of claims within designated authority.
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
- 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 our clients.
- 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 is correct.
- Refers cases as appropriate to supervisor and management.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
Requirements
- Bachelor's degree from an accredited college or university preferred
- Professional certification as applicable to line of business preferred
- Five (5) years of claims management experience or equivalent combination of education and experience required
- 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 line-of-business
- Excellent oral and written communication, including presentation skills
- 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 Expectations
Benefits
- Medical
- Dental
- Vision
- 401k and matching
- PTO
- Disability and life insurance
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
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