Workers’ Compensation Claims Consultant – Level 2

🔥 23 minutes ago

🇨🇦 Canada – Remote

💵 $65k - $80k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

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Sedgwick

WebsiteLinkedInAll Job Openings

10,000+ employees

🏗️ Construction

💼 Consulting

🏥 Healthcare

Construction • Consulting • Healthcare

Sedgwick is a global provider of technology-enabled risk, benefits, and integrated business solutions. They help people and organizations by managing and mitigating risk with solutions in accident, health, disability, unemployment compensation, and liability claims administration, among others. Sedgwick offers services such as claims administration, building consulting, forensic accounting, and forensic engineering. Their specialties include property restoration, brand protection, and loss prevention across several industries, including agriculture, construction, and environmental sectors. The company emphasizes diversity, equity, and inclusion (DEI) as well as environmental, social, and governance (ESG) practices.

📋 Description

• Analyze and process complex or technically challenging workers’ compensation claims by investigating and gathering information to determine claim exposure. • Manage claims through action plans to achieve appropriate and timely resolution. • Negotiate claim settlements within designated authority limits. • Calculate and allocate appropriate reserves in a timely manner and manage their adequacy throughout the life of the claim. • Calculate and issue benefits owed; approve and process payments and adjustments; settle claims within authority limits. • Prepare required provincial filings within statutory deadlines. • Manage the litigation process and ensure prompt, cost-effective resolution. • Coordinate vendor recommendations for additional investigations or litigation management. • Use cost-containment techniques, including strategic partnerships with vendors. • Manage recoveries, including subrogation, Second Injury Fund recoveries, and Social Security and Medicare offsets. • Report claims to excess insurers and respond professionally to requests for direction. • Communicate claim activity and handling with claimants and clients. • Maintain professional relationships with clients. • Ensure proper file documentation and accurate coding. • Refer files to supervisors and management when necessary. • Perform other duties as assigned. • Support the organization’s quality programs. • Travel as required.

🎯 Requirements

• Bachelor’s degree from an accredited university or college preferred. • Four (4) years of claims management experience, or an equivalent combination of education and experience. • Five (5) years of claims management experience, or an equivalent combination of education and experience, required. • Working knowledge of applicable regulations, compensation and offsets, disability duration, medical management practices, and Social Security and Medicare claim procedures relevant to the applicable line of business. • Strong knowledge of workers’ compensation legislation and health and safety standards. • Proven ability to manage complex claims processes and collaborate with stakeholders. • Experience with HR leave programs, disability case management, and policy interpretation. • Paralegal expertise in handling claims, appeals, and compliance matters. • Excellent oral and written communication skills, including presentation skills. • Proficiency with computer applications, including Microsoft Office products. • Strong analytical and interpretive skills. • Strong organizational skills. • Good interpersonal skills. • Excellent negotiation skills. • Ability to work effectively in a team environment. • Ability to meet or exceed service expectations. • Professional certification applicable to the line of business preferred. • Ability to travel as required.

🏖️ Benefits

• Work-life balance • Caring culture • Inclusive, barrier-free recruitment and selection processes • Accommodation available during recruitment and selection, if required

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