Claims Examiner – Workers Compensation

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🏰 Missouri – Remote

🏰 Missouri – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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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 difficult workers' compensation claims by investigating and gathering information to determine claim exposure • Manage claims through action plans to timely and appropriate resolution • Negotiate claim settlements within designated authority • Calculate and assign timely and appropriate reserves and manage reserve adequacy • Calculate and pay benefits, approve claim payments and adjustments, and settle claims within authority • Prepare necessary state filings within statutory limits • Manage litigation to ensure timely and cost-effective claim resolution • Coordinate vendor referrals for investigation and litigation management • Apply cost-containment techniques and strategic vendor partnerships • Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets • Report claims to excess carriers and respond to direction requests • Communicate claim activity with claimants and clients and maintain professional client relationships • Ensure claim files are properly documented and claim coding is correct • Refer cases to supervisors and management as appropriate • Perform other assigned duties and support organizational quality programs • Travel as required

🎯 Requirements

• Five (5) years of claims management experience or equivalent combination of education and experience required • Subject matter expertise in insurance principles and laws for the applicable line of business • Knowledge of recoveries, offsets and deductions, claim and disability duration, and cost-containment principles • Knowledge of medical management practices and Social Security and Medicare application procedures as applicable • Excellent oral and written communication, including presentation skills • PC literacy, 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 • Ability to handle multiple priorities, deadlines, work-related stress, troubleshooting, problem solving, analysis, and discretion • Computer keyboarding ability • Professional certification as applicable to the line of business preferred • Bachelor's degree from an accredited college or university preferred

🏖️ Benefits

• Work-life balance • Caring culture • Reasonable accommodations when applicable and appropriate • Equal Opportunity Employer • Drug-Free Workplace