Claims Examiner - Workers Compensation | Jurisdiction: NY | Licensing: NY

Claims Examiner - Workers Compensation

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

WORK LOCATIONS: Hybrid if located within a 25 mile radius of any Sedgwick Offices.

PRIMARY PURPOSE OF THE ROLE: To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

ESSENTIAL RESPONSIBILITIES MAY INCLUDE:

• Manages complex workers' compensation claims from initial investigation through final resolution
• Evaluates claim exposure and develops action plans to drive timely, effective outcomes
• Negotiates settlements within authority while ensuring compliance with guidelines
• Establishes and maintains accurate reserves throughout the life of each claim
• Calculates and issues benefit payments, adjustments, and settlements in a timely manner
• Prepares and submits required state filings within statutory deadlines
• Oversees litigation, partnering with vendors to manage strategy and control costs
• Applies cost containment strategies, including use of preferred vendor partnerships
• Handles claim recoveries such as subrogation, Second Injury Fund, and Medicare/SS offsets
• Reports to excess carriers and responds to requests promptly and professionally
• Communicates regularly with claimants and clients to provide updates and maintain strong relationships
• Ensures claim files are well-documented and coded accurately
• Escalates complex or high-risk cases to leadership as appropriate

QUALIFICATIONS

Education & Licensing: High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience: 5 years of claims management experience or equivalent combination of education and experience required.

Licensing / Jurisdiction Knowledge: NY jurisdiction and NY licensing

TAKING CARE OF YOU

• 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.

WORK ENVIRONMENT REQUIREMENTS INCLUDE: 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

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is (63,404.00 - 85,000 USD Annual). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

#claimsexaminer #claims #hybrid #LI-REMOTE

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.