Sedgwick
Claims Examiner - Workers Compensation | Jurisdiction TX, OK, LA | Licensing in
Sedgwick, Granite Heights, Wisconsin, United States
Claims Examiner – Workers Compensation (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 Career Overview
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 knowledge and experience to adjudicate complex customer claims in 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 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 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. Ideal Candidate
To analyze complex or technically difficult workers’ compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. 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. Essential Responsibilities
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 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 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 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 program(s). Travel as required. Qualifications
Education and Licensing
• Bachelor’s degree from an accredited college or university preferred. • Licenses as required. • Professional certifications as applicable to line of business preferred. Experience
• Five (5) years of claims management experience or equivalent combination of education and experience required. Jurisdiction & Licensing
• Jurisdiction: TX, OK, and LA. • Licensing: TX, OK, or LA preferred. Taking Care of You
Flexible work schedule. Referral incentive program. Opportunity to work in an agile environment. Career development and promotional growth opportunities. Comprehensive benefits offering including medical, dental, vision, 401(k) on day one. 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.
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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 Career Overview
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 knowledge and experience to adjudicate complex customer claims in 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 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 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. Ideal Candidate
To analyze complex or technically difficult workers’ compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements. 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. Essential Responsibilities
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 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 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 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 program(s). Travel as required. Qualifications
Education and Licensing
• Bachelor’s degree from an accredited college or university preferred. • Licenses as required. • Professional certifications as applicable to line of business preferred. Experience
• Five (5) years of claims management experience or equivalent combination of education and experience required. Jurisdiction & Licensing
• Jurisdiction: TX, OK, and LA. • Licensing: TX, OK, or LA preferred. Taking Care of You
Flexible work schedule. Referral incentive program. Opportunity to work in an agile environment. Career development and promotional growth opportunities. Comprehensive benefits offering including medical, dental, vision, 401(k) on day one. 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.
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