Claims Examiner - Workers Compensation

Claims Examiner – Workers Compensation Dedicated Account | Licensing: TX | Jurisdiction: TX 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. Responsibilities Analyze complex or technically difficult workers' compensation claims to determine benefits due. Work with high exposure claims involving litigation and rehabilitation. Ensure ongoing adjudication of claims within service expectations, industry best practices, and client service requirements. Identify subrogation of claims and negotiate settlements. Manage claims through well-developed action plans to an appropriate and timely resolution. Negotiate settlement of claims within designated authority. Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim. Calculate and pay benefits due; approve and make timely claim payments and adjustments; and settle claims within designated authority level. Prepare necessary state filings within statutory limits. Manage the litigation process; ensure timely and cost-effective claims resolution. Coordinate vendor referrals for additional investigation and/or litigation management. Use cost containment techniques, including strategic vendor partnerships, to reduce overall cost of claims for clients. Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets. Report claims to the excess carrier; respond to requests for directions in a professional and timely manner. Communicate claim activity and processing with the claimant and the client; maintain professional client relationships. Ensure claim files are properly documented and claims coding is correct. Refer cases as appropriate to supervisor and management. Perform other duties as assigned. Support the organization's quality programs. Travel as required. Qualifications Bachelor's degree from an accredited college or university (preferred). Required: Licenses as required; professional certifications applicable to line of business (preferred). Required: Five (5) years of claims management experience or equivalent combination of education and experience. Jurisdiction/Licensing: Texas. Benefits and Work Environment Flexible work schedule. Referral incentive program. Opportunity to work in an agile environment. Career development and promotional growth opportunities. Diverse and comprehensive benefits offering including medical, dental, vision, and 401(k) on day one. Work from home if outside 25-mile radius of Sedgwick office; otherwise hybrid schedule. Work environment considers reasonable accommodations when applicable. Physical: Computer keyboarding, travel as required. Auditory/Visual: Hearing, vision, and talking. Mandatory Statements We offer reasonable accommodations for applicants and employees with disabilities. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. #J-18808-Ljbffr