Claims Examiner – Workers Compensation, Southeast Exp Preferred, Licensing: NC

Sedgwick

Claims Examiner adjudicating complex workers' compensation claims for Sedgwick. Analyzing, negotiating settlements, and ensuring compliance with service expectations and best practices.

Posted 5/19/2026full-timeRemote • Alabama, Florida, North Carolina, Tennessee • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

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.
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.

Requirements

What you’ll need

Bachelor's degree from an accredited college or university preferred.
Five (5) years of claims management experience or equivalent combination of education and experience required.
Jurisdiction Knowledge: Southeast States, North Carolina Licensing: NC, reciprocals

Benefits

Comp & perks

Flexible work schedule.
Referral incentive program.
Opportunity to work in an agile environment.
Career development and promotional growth opportunities.
A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims managementworkers' compensation claimsnegotiationreserve calculationclaims processinglitigation managementcost containment techniquessubrogationclaims codingstatutory compliance

Soft Skills

communicationrelationship managementanalytical thinkingproblem-solvingorganizational skillsattention to detailtime managementprofessionalismteam collaborationadaptability

Certifications

Bachelor's degreeNorth Carolina Licensing