Senior Claims Examiner - Workers Compensation
Company: Sedgwick
Location: Sacramento
Posted on: June 25, 2022
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Job Description:
**The 'Apply with SEEK' option will be utilized for
International applicants, mainly Australia. If this does not apply
to you please use the 'Apply' option.**Senior Claims Examiner -
Workers CompensationIF YOU CARE, THERE'S A PLACE FOR YOU HEREFor a
career path that is both challenging and rewarding, join Sedgwick's
talented team of 27,000 colleagues around the globe. Sedgwick is a
leading provider of technology-enabled risk, benefits and
integrated business solutions. Taking care of people is at the
heart of everything we do. Millions of people and organizations
count on Sedgwick each year to take care of their needs when they
face a major life event or something unexpected happens. Whether
they have a workplace injury, suffer property or financial loss or
damage from a natural or manmade disaster, are involved in an auto
or other type of accident, or need time away from work for the
birth of a child or another medical situation, we are here to
provide compassionate care and expert guidance. Our clients depend
on our talented colleagues to take care of their most valuable
assets-their employees, their customers and their property. At
Sedgwick, caring counts -. Join our team of creative and caring
people of all backgrounds, and help us make a difference in the
lives of others.For more than 50 years, Sedgwick has been helping
employers answer virtually every question there is about workers'
compensation. We have experience in nearly every type of industry
and region and provide the industry's broadest range of programs
and services.**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**Five (5) 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.\#L1-TS1Sedgwick is an Equal Opportunity Employer and a
Drug-Free Workplace.
Keywords: Sedgwick, Sacramento , Senior Claims Examiner - Workers Compensation, Other , Sacramento, California
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