Claims Examiner – Workers Compensation, Reciprocal Required

🕒 April 21

🌲 North Carolina – Remote

🌲 North Carolina – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• 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 claims within designated authority level. • Prepares necessary state filings 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. • Travels as required.

🎯 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. • Licensing: Reciprocal 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

• Flexible work schedule. • Referral incentive program. • Opportunity to work in an agile environment. • Career development and promotional growth opportunities. • A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.