WC Claims Examiner – Dedicated Client, MD Jurisdiction
Sedgwick
full-time
Posted on:
Location Type: Hybrid
Location: Hunt Valley • Maryland • United States
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About the role
- Analyze complex or technically difficult workers' compensation claims to determine benefits due
- Work with high exposure claims involving litigation and rehabilitation
- Ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements
- Identify subrogation of claims and negotiate settlements
- Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim
- Manage claims through well-developed action plans to an appropriate and timely resolution
- Negotiate settlement of claims within designated authority
- Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim
- Prepare necessary state fillings within statutory limits
- Manage the litigation process; ensure timely and cost-effective claims resolution
- Coordinate vendor referrals for additional investigation and/or litigation management
- Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients
- Manage claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets
- Report claims to the excess carrier; respond to requests of directions in a professional and timely manner
- Communicate claim activity and processing with the claimant and the client; maintain professional client relationships
- Ensure claim files are properly documented and claims coding is correct
- Refer cases as appropriate to supervisor and management
Requirements
- Bachelor's degree from an accredited college or university preferred
- 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
- Excellent oral and written communication, including presentation skills
- 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
Benefits
- Health insurance
- 401(k) retirement plans
- Paid time off
- Flexible work arrangements
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims managementnegotiationsubrogationcost containmentclaims codingreserve managementlitigation managementmedical management practicesanalytical skillspresentation skills
Soft skills
communicationorganizational skillsinterpersonal skillsteamworknegotiation skillsanalytical skills