Claims Examiner – Workers Compensation
Sedgwick
full-time
Posted on:
Location Type: Hybrid
Location: Portland • Oregon • 🇺🇸 United States
Visit company websiteSalary
💰 $65,000 - $90,000 per year
Job Level
Mid-LevelSenior
About the role
- 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 filings 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
Requirements
- Bachelor's degree from an accredited college or university preferred
- Professional certification as applicable to line of business preferred
- Five (5) years of claims management experience or equivalent combination of education and experience required
Benefits
- Flexible Work Schedule
- Referral Incentive Program
- Opportunity to work from home
- Career development and promotional growth opportunities
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day 1
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims managementworkers' compensation claimsnegotiationreserve calculationclaims settlementlitigation managementcost containment techniquessubrogationclaims codingstatutory filings
Soft skills
analytical skillscommunicationclient relationship managementproblem-solvingorganizational skillstime managementprofessionalismteam collaborationattention to detailadaptability
Certifications
Bachelor's degreeprofessional certification