Claims Examiner I

🕒 April 14

🇺🇸 United States – Remote

💵 $63.4k - $85k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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Sedgwick

WebsiteLinkedInAll Job Openings

10,000+ employees

🏢 Enterprise

📋 Compliance

Insurance • Enterprise • Compliance

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 complex or technically difficult workers' compensation claims to determine benefits due • Work with high exposure claims involving litigation and rehabilitation • Ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements • Identify subrogation of claims and negotiate settlements • Investigate and gather information to determine the exposure on the claim • Negotiate settlement of claims within designated authority • Calculate and assign timely and appropriate reserves to claims • Manage reserve adequacy throughout the life of the claim • Approve and make timely claim payments and adjustments • Prepare necessary state fillings within statutory limits • Manage the litigation process and ensure timely claims resolution • Coordinate vendor referrals for additional investigation and/or litigation management

🎯 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 • 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