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Sedgwick · 1 day ago

WC Claims Examiner - Hybrid Schedule - Dedicated Client/MD Jurisdiction

Hunt Valley, MD

Full-time

Hybrid

Senior Level

5+ years exp

Sedgwick is a company dedicated to helping people facing unexpected challenges, with a commitment to a caring culture and work-life balance. They are seeking a WC Claims Examiner to analyze complex workers' compensation claims, manage litigation processes, and ensure timely resolution of claims while maintaining professional relationships with clients. The role involves negotiation, settlement of claims, and adherence to service expectations and industry best practices.

BankingInsuranceRisk Management

Responsibilities

Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution

Negotiates settlement of claims within designated authority

Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim

Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level

Prepares necessary state fillings within statutory limits

Manages the litigation process; ensures timely and cost effective claims resolution

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

Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets

Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner

Communicates claim activity and processing with the claimant and the client; maintains professional client relationships

Ensures claim files are properly documented and claims coding is correct

Refers cases as appropriate to supervisor and management

Performs other duties as assigned

Supports the organization's quality program(s)

Travels as required

Qualification

Claims management experienceInsurance principles knowledgeNegotiation skillsAnalytical skillsCommunication skillsService expectationsPC literacyOrganizational skillsInterpersonal skillsTeamwork ability

Required

Five (5) years of claims management experience or equivalent combination of education and experience

Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business

Excellent oral and written communication, including presentation skills

PC literate, including Microsoft Office products

Analytical and interpretive skills

Strong organizational skills

Good interpersonal skills

Excellent negotiation skills

Ability to work in a team environment

Ability to meet or exceed Service Expectations