Claims Examiner - Workers Compensation

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🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ 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

• Manages mid-level water damage 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. • Assesses liability and resolves claims within evaluation. • Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract. • Manages subrogation of claims and negotiates settlements. • Communicates claim action with claimant and client. • Ensures claim files are properly documented and claims coding is correct. • May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review. • Maintains professional client relationships. • Performs other duties as assigned. • Supports the organization's quality program(s).

🎯 Requirements

• 4 years of Liability claims management experience or equivalent combination of education and experience required. • Bachelor's degree from an accredited college or university preferred.

🏖️ Benefits

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