Claims Examiner - Workers' Comp

Claims Examiner - Workers' Comp This role requires the candidate to reside in the state of Ohio. Applicants must have experience handling or supporting workers' compensation claims, including familiarity with claims processes, documentation, and guidelines. ESSENTIAL RESPONSIBILITIES Analyze and process complex or technically difficult claims by investigating and gathering information to assist employers in determining their position on the claim; manage claims through well-developed action plans to an appropriate and timely resolution. Work to move claims towards appropriate closure which may include referral for settlement evaluation. Monitor reserve adequacy throughout the life of the claim if applicable. Monitor and review benefits due and payment calculations ensuring accuracy. Prepare necessary state filings within statutory limits. Follow best practice standards in contested claims including outside legal representation. Coordinate vendor referrals for additional investigation and/or litigation management. Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for clients. Participate in claim recoveries including subrogation, Second Injury Fund recoveries, and Social Security offsets. Communicate claim action/processing with appropriate parties including claimant, client, state agency, managed care organization and appropriate medical contact. Ensure claims files are properly documented and claims coding is correct. Maintain professional client relationships. Coordinate actuarial/settlement issues impacting employers with rate and settlement departments. Assess policy level status of clients; work in coordination with client-service expectations and assigned service personnel. QUALIFICATIONS Education & Licensing: 4 years of claims management experience or equivalent combination of education and experience required. 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. BENEFITS Flexible work schedule. Referral incentive program. Opportunity to work in an agile environment. [IF APPLICABLE] Career development and promotional growth opportunities. A diverse and comprehensive benefits offering including medical, dental, vision, 401K on day one. Work environment requirements for entry-level opportunities include – Physical: Computer keyboarding Auditory/visual: Hearing, vision and talking Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines. 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 $73,000 - $75,000. 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. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. #J-18808-Ljbffr