Claims Examiner – Workers Compensation, TX/OK/LA Licensing
Sedgwick
full-time
Posted on:
Location Type: Hybrid
Location: Plano • Louisiana • Oklahoma • United States
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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 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.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
Requirements
- Bachelor's degree from an accredited college or university preferred.
- Licenses as required.
- Professional certifications as applicable to line of business preferred.
- Five (5) years of claims management experience or equivalent combination of education and experience required.
Benefits
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Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims managementnegotiationreserve calculationclaims processinglitigation managementcost containment techniquessubrogationclaims codingstate filingsvendor management
Soft Skills
communicationprofessional relationship managementanalytical thinkingproblem-solvingorganizational skills
Certifications
professional certifications