CLAIMS EXAMINER - WORKERS COMP (REMOTE)
: Job Details :


CLAIMS EXAMINER - WORKERS COMP (REMOTE)

Access Dubuque

Location: Dubuque,IA, USA

Date: 2024-10-22T07:25:31Z

Job Description:

Claims Examiner - Workers Comp (Remote)

**Sedgwick**

1 Positions

ID: R54354

Posted On 10/07/2024

**Job Overview**

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. Its an opportunity to do something meaningful, each and every day. Its having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if youre someone who cares, theres a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work

Most Loved Workplace

Forbes Best-in-State Employer

Claims Examiner - Workers Comp (Remote)

**PRIMARY PURPOSE** : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements

**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**

+ 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 clams within designated authority level.

+ Prepares necessary state fillings 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.

+ Refers cases as appropriate to supervisor and management.

**ADDITIONAL FUNCTIONS and RESPONSIBILITIES**

+ Performs other duties as assigned.

+ Supports the organization's quality program(s).

+ Travels as required.

**QUALIFICATION**

**Education & Licensing**

Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

**Experience**

At least two (2) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

+ 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

**WORK ENVIRONMENT**

When applicable and appropriate, consideration will be given to reasonable accommodations.

**Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

**Physical:** Computer keyboarding, travel as required

**Auditory/Visual:** Hearing, vision and talking

**NOTE** : Credit security clearance, confirmed via a background credit check, is required for this position.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**

Primary Contact

164#######738

Amanda Strothman

,

Phone

Phone

Phone

Fax

...@sedgwick.com

Email

True

False

True

**Job Details**

Categories

Insurance

Management/Executive

Technical

Location

Dubuque, IA

Job Type

Employee

Full/Part

Full Time

Company ID

8326

Job REQ #

R54354

# Positions

1

Start Date

20241007

End Date

20241121

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Sedgwick

**About the Company**

**Career Development**

Our goal is to make Sedgwick CMS a place where great people can do great things for our clients. This commitment is evidenced by our colleague development program and supported by our multi-dimensional learning resources.

We invest in the education of our colleagues by providing training and learning resources that focus on our culture, procedures, systems and performance expectations. We evaluate the educational needs of our colleagues through performance discussions and evaluations. These needs are filled either through Sedgwick CMS University and through industry certification programs and other external educational resources . Sedgwick CMS University curriculum offerings take colleagues from orientation to technical training to supervisory and managerial development. Through Sedgwick CMS University, we provide our colleagues continuous development of professional skills and the ability to deliver quality service to our clients.

**Colleague Orientation**

We offer a required colleague orientation program that allows us to verify and document the training provided to new colleagues. This program is called Personal Responsibility in Developing Excellence (PRIDE) and is the first component of our comprehensive career development process. This program introduces and orients new and transitioning colleagues to our company and to their new position. PRIDE will take colleagues through the first 90 days of their new position. Objectives of this program focus on providing colleagues an increased awareness of who we are, where we are going, and how they can help us get there.

**Career Paths**

Career path options are identified through an ongoing process of discussion and collaboration between colleagues and their managers. On an ongoing basis, our managers counsel colleagues regarding their career path, new opportunities, and additional training and development requirements to help them reach their individual goals.

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