Claims Examiner III, Workers' Compensation

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CLAIM YOUR FUTURE AS A GREAT PERFORMER!


Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been recently voted the Best TPA in America and the first and only Third Party Administrator to receive the coveted Employer of Choice® designation. Come be a part of our team and "Claim Your Future."


PRIMARY PURPOSE: To analyze complex workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within company standards, industry best practices and specific client service requirements; and to manage subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

Analyzes and processes worker's compensation claims by investigating and gathering information to determine the exposure on the claim. Negotiates settlement of claims up to designated authority level and makes claim payments. Processes complex or technically difficult claims. Calculates and assigns timely and appropriate reserves to claims and continues to monitor reserve adequacy throughout the life of the claim. Develops and manages claims through well developed action plans. Prepares necessary state filings within statutory limits. Actively manages the litigation process. Determines benefits due; makes timely claims payments and adjustments. 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 of all types. Reports claims to the excess carrier. Frequently communicates claim activity and processing with the ill or injured party and the client. Maintains professional client relationships. Maintains a quality assurance program to support the Total Performance Management initiative and the consistent delivery of quality claims service.
REQUIREMENTS
Education & Licensing:

Baccalaureate degree from an accredited college or university preferred
Licenses as required
Professional certification as applicable to Workers Compensation preferred

Experience: Five (5) years of Workers' Compensation claims management experience required



Skills & Knowledge:


Thorough knowledge of appropriate insurance principles and laws for Workers' Compensation


Recoveries offsets and deductions


Claim and disability duration
Cost containment principles including medical management practices and Social Security application procedures as applicable to Workers' Compensation


Excellent oral and written communication skills, including presentation skills
PC literate, including Microsoft Office products
Effective analytical and interpretive skills
Strong organizational skills
Persuasive negotiation skills
Good interpersonal skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies

Sedgwick CMS is an Equal Opportunity Employer