Sedgwick
Claims Examiner - Workers Compensation | Jurisdiction: TX,OK,LA | TX License pre
Sedgwick, Plano, Texas, us, 75086
Claims Examiner - Workers Compensation - Must Reside in Texas (Remote)
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.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies. Certified as a Great Place to Work®. Fortune Best Workplaces in Financial Services & Insurance.
Apply your knowledge and experience to adjudicate complex customer claims in an energetic culture.
Deliver innovative customer‑facing solutions to clients in virtually every industry.
Be part of a rapidly growing, industry‑leading global company known for its excellence and customer service.
Leverage Sedgwick’s global network of experts to learn, share insights.
Take advantage of varied professional development opportunities.
Enjoy flexibility and autonomy in daily work, location, and career path.
Access diverse and comprehensive benefits for mental, physical, financial, and professional needs.
ARE YOU AN IDEAL CANDIDATE? To 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 specific client service requirements; identify subrogation of claims and negotiate settlements.
PRIMARY PURPOSE OF THE ROLE We are looking for driven individuals who embody our caring counts model and core values: empathy, accountability, collaboration, growth, and inclusion.
OFFICE LOCATION The selected candidate will be expected to work a hybrid schedule if within 25 miles of a Sedgwick office; if outside of this radius it will be work from home.
ESSENTIAL RESPONSIBILITIES MAY INCLUDE
Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manage claims through well‑developed action plans to a 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; 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 appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
Manage claim recoveries, including but not limited to subrogation, second injury fund excess recoveries, and social security and Medicare offsets.
Report claims to the excess carrier; respond to requests or 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 claim coding is correct.
Refer cases as appropriate to supervisor and management.
Perform other duties as assigned.
Support the organization’s quality program(s).
Travel 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 an equivalent combination of education and experience required.
TAKING CARE OF YOU
Flexible work schedule.
Referral incentive program.
Career development and promotional growth opportunities.
Diverse and comprehensive benefits offering including medical, dental, vision, 401(k) on day one.
Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace.
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Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies. Certified as a Great Place to Work®. Fortune Best Workplaces in Financial Services & Insurance.
Apply your knowledge and experience to adjudicate complex customer claims in an energetic culture.
Deliver innovative customer‑facing solutions to clients in virtually every industry.
Be part of a rapidly growing, industry‑leading global company known for its excellence and customer service.
Leverage Sedgwick’s global network of experts to learn, share insights.
Take advantage of varied professional development opportunities.
Enjoy flexibility and autonomy in daily work, location, and career path.
Access diverse and comprehensive benefits for mental, physical, financial, and professional needs.
ARE YOU AN IDEAL CANDIDATE? To 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 specific client service requirements; identify subrogation of claims and negotiate settlements.
PRIMARY PURPOSE OF THE ROLE We are looking for driven individuals who embody our caring counts model and core values: empathy, accountability, collaboration, growth, and inclusion.
OFFICE LOCATION The selected candidate will be expected to work a hybrid schedule if within 25 miles of a Sedgwick office; if outside of this radius it will be work from home.
ESSENTIAL RESPONSIBILITIES MAY INCLUDE
Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manage claims through well‑developed action plans to a 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; 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 appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
Manage claim recoveries, including but not limited to subrogation, second injury fund excess recoveries, and social security and Medicare offsets.
Report claims to the excess carrier; respond to requests or 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 claim coding is correct.
Refer cases as appropriate to supervisor and management.
Perform other duties as assigned.
Support the organization’s quality program(s).
Travel 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 an equivalent combination of education and experience required.
TAKING CARE OF YOU
Flexible work schedule.
Referral incentive program.
Career development and promotional growth opportunities.
Diverse and comprehensive benefits offering including medical, dental, vision, 401(k) on day one.
Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace.
#J-18808-Ljbffr