Claims Examiner - Workers Compensation | Jurisdiction: Southeast Exp Preferred | Licensing: NC [...]

Claims Examiner - Workers Compensation | Jurisdiction: Southeast | Exp Preferred | Licensing: NC | Remote Primary Purpose of the Role We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. Essential 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 claims 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. Performs other duties as assigned. Supports the organization's quality program(s). Travels as required. Qualifications Education and 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. Jurisdiction Knowledge: Southeast States, North Carolina. Licensing: NC, reciprocals. Benefits 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, and 401K on day one. Work Environment When applicable and appropriate, consideration will be given to reasonable accommodations. Physical: Computer keyboarding, travel as required. Auditory/Visual: Hearing, vision and talking. 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. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. #J-18808-Ljbffr