Claims Examiner - Workers' Comp

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.

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Claims Examiner - Workers' Comp

This role requires the candidate to reside in the state of Ohio. Additionally, applicants must have experience handling or supporting workers' compensation claims, including familiarity with claims processes, documentation, and guidelines.

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands?

• Apply your examiner knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

• Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations.

• Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.

• Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights.

• Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.

• Enjoy flexibility and autonomy in your daily work, your location, and your career path.

• Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

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.

ARE YOU AN IDEAL CANDIDATE? 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 RESPONSIBLITIES MAY INCLUDE

• Analyzes and processes complex or technically difficult claims by investigating and gathering information to assist employer in determining their position on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

• Works to move claim towards appropriate claim closure which may include referral for settlement evaluation.

• Monitors reserve adequacy throughout the life of the claim if applicable.

• Monitors and reviews benefits due and payment calculations ensuring accuracy.

• Prepares necessary state filings within statutory limits.

• Follows best practice standards in contested claims including outside legal representation.

• 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.

• Participates in claim recoveries including, but not limited to: subrogation, Second Injury Fund recoveries, and Social Security offsets.

• Communicates claim action/processing with appropriate parties including, but not limited to: claimant, client, state agency, managed care organization and appropriate medical contact.

• Ensures claims files are properly documented and claims coding is correct.

• Maintains professional client relationships.

• Coordinates actuarial/settlement issues impacting employers with rate and settlement departments.

• Assesses policy level status of clients; works in coordination with clients' 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.

TAKING CARE OF YOU

• 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.

NEXT STEPS

If your application is selected to advance to the next round, a recruiter will be in touch.

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.

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.

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.

Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com