Claims Examiner – Workers Compensation
Sedgwick
full-time
Posted on:
Location Type: Office
Location: Bartlesville • Oklahoma • 🇺🇸 United States
Visit company websiteSalary
💰 $75,000 - $85,000 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
- 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
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
- 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
- PC literate, including Microsoft Office products
Benefits
- medical
- dental
- vision
- 401k and matching
- PTO
- disability and life insurance
- employee assistance
- flexible spending or health savings account
- other additional voluntary benefits
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 settlementstate filingslitigation managementcost containmentmedical management practicesSocial Security and Medicare application procedures
Soft skills
analytical skillscommunicationproblem-solvingnegotiation skillsorganizational skillsattention to detailtime managementinterpersonal skillsdecision-makingvendor coordination
Certifications
professional certification in insurance