Claims Examiner - Workers' Comp

Primary Purpose Analyze Workers' Compensation claims on behalf of valued clients to determine benefits due and ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. Essential Responsibilities Analyze and process complex or technically difficult claims, investigating and gathering information to assist employers in determining their position on the claim. Manage claims through well‑developed action plans toward timely resolution and appropriate closure, including referral for settlement evaluation. Monitor reserve adequacy throughout the life of the claim, if applicable, and review benefits due and payment calculations to ensure accuracy. Prepare necessary state filings within statutory limits and follow best‑practice standards for contested claims, including outside legal representation. Coordinate vendor referrals for additional investigation and/or litigation management, using cost‑containment techniques to reduce overall claim costs. Participate in claim recoveries such as subrogation, Second Injury Fund recoveries, and Social Security offsets. Communicate claim actions with parties including claimants, clients, state agencies, managed care organizations, and medical contacts. Ensure claims files are properly documented and claims coding is correct, maintaining professional client relationships. Coordinate actuarial/settlement issues impacting employers with rate and settlement departments. Assess policy‑level status of clients and work in coordination with clients’ service expectations and assigned personnel. Qualifications 4 years of claims management experience or an equivalent combination of education and experience. High School Diploma or GED required; Bachelor’s degree preferred. Professional certification in a relevant line of business preferred. Strong analytical, judgment, and communication skills. Ability to meet deadlines and work independently in a flexible, agile environment. Benefits and Work Environment Competitive starting salary of $73,000 - $75,000 (Ohio). Medical, dental, vision, 401(k) with employer match, PTO, disability and life insurance, and flexible spending accounts. Referral incentive program, career development, and promotional growth opportunities. Flexible work schedule and autonomy in daily work. Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace. #J-18808-Ljbffr Sedgwick