Claims Examiner II
Workers Compensation
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick has a strong commitment to its colleagues and its clients. If you are seeking place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick is the place for you. As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as the Best TPA in America and the coveted Employer of Choice designation, we invite you to come be a part of our team and, ?Claim Your Future.?
PRIMARY PURPOSE : To analyze mid and higher-level workers compensation, general liability or disability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to manage subrogation of claims and negotiate settlements.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Processes general liability claims by gathering information to determine liability exposure, assigns reserve values to claims, making claims payments as necessary and settling claims up to designated authority level.
Processes 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 disability claims, determines benefits due, and manages action plan pursuant to the disability claim or client contract.
Manages subrogation of claims and negotiates settlements.
Communicates claim action/processing with claimant and client.
Ensures claim files are properly documented and claims coding is correct.
Maintains professional client relationships.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
QUALIFICATIONS
Education & Licensing
Baccalaureate degree from an accredited college or university preferred. Licenses as required.
Experience
Two (2) years of claims management experience or successful completion of Claims Examiner II training required.
Skills & Knowledge
Knowledge of ERISA regulations, offsets and deductions, disability duration, medical management practices and Social Security 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
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When 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 deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE : 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 .
Sedgwick is an Equal Opportunity Employer
and a
Drug-Free Workplace
Additional Information: N/A
Requisition #: 7645
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