(Remote) Claims Examiner - Workers Compensation - Midwest Jurisdictions
Company: Sedgwick
Location: Detroit
Posted on: January 27, 2023
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Job Description:
Taking care of people is at the heart of everything we do, and
we start by taking care of you, our valued colleague. A career at
Sedgwick means experiencing our culture of caring. It means having
flexibility and time for all the things that are important to you.
It's an opportunity to do something meaningful, each and every day.
It's having support for your mental, physical, financial and
professional needs. It means sharpening your skills and growing
your career. And it means working in an environment that celebrates
diversity and is fair and inclusive.A career at Sedgwick is where
passion meets purpose to make a positive impact on the world
through the people and organizations we serve. If you are someone
who is driven to make a difference, who enjoys a challenge and
above all, if you're someone who cares, there's a place for you
here. Join us and contribute to Sedgwick being a great place to
work.Great Place to Work -Most Loved Workplace -Forbes
Best-in-State Employer(Remote) Claims Examiner - Workers
Compensation - Midwest Jurisdictions**PRIMARY PURPOSE** : 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.**BENEFITS**Competitive salaryFlexible work
scheduleReferral incentive programOpportunity to work from
homeInternal career progression and developmentBenefits eligibility
and 401(k) with company match day 1**ESSENTIAL FUNCTIONS and
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 clams
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.**ADDITIONAL FUNCTIONS and
RESPONSIBILITIES**+ Performs other duties as assigned.+ Supports
the organization's quality program(s).+ Travels as
required.**QUALIFICATIONS****Education & Licensing**Bachelor's
degree from an accredited college or university preferred.
Professional certification as applicable to line of business
preferred.+ Midwest claims handling experience.**Experience**Five
(5) years of claims management experience or equivalent combination
of education and experience required.**Skills & Knowledge**+
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**WORK ENVIRONMENT**When applicable and appropriate,
consideration will be given to reasonable
accommodations.**Mental:** Clear and conceptual thinking ability;
excellent judgment, troubleshooting, problem solving, analysis, and
discretion; ability to handle work-related stress; ability to
handle multiple priorities simultaneously; and ability to meet
deadlines**Physical:** Computer keyboarding, travel as
required**Auditory/Visual:** Hearing, vision and talking**NOTE** :
Credit security clearance, confirmed via a background credit check,
is required for this position.The statements contained in this
document are intended to describe the general nature and level of
work being performed by a colleague assigned to this description.
They are not intended to constitute a comprehensive list of
functions, duties, or local variances. Management retains the
discretion to add or to change the duties of the position at any
time. #LI-RemoteSedgwick 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.****Taking care of people is at
the heart of everything we do. Caring counts**Sedgwick is a leading
global provider of technology-enabled risk, benefits and integrated
business solutions. Every day, in every time zone, the most
well-known and respected organizations place their trust in us to
help their employees regain health and productivity, guide their
consumers through the claims process, protect their brand and
minimize business interruptions. Our more than 30,000 colleagues
across 80 countries embrace our shared purpose and values as they
demonstrate what it means to work for an organization committed to
doing the right thing - one where caring counts. Watch this video
to learn more about us.
(https://www.youtube.com/watch?v=ywxedjBGSfA)
Keywords: Sedgwick, Detroit , (Remote) Claims Examiner - Workers Compensation - Midwest Jurisdictions, Other , Detroit, Michigan
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