Examiner Claims Associate Workers Compensation

Sedgwick Claims Management Services, Inc. Orange , CA 92856

Posted 2 months ago

The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.

Examiner Claims Associate Workers Compensation

IF YOU CARE, THERE'S A PLACE FOR YOU HERE

For a career path that is both challenging and rewarding, join Sedgwick's talented team of 27,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets-their employees, their customers and their property. At Sedgwick, caring counts. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.

For more than 50 years, Sedgwick has been helping employers answer virtually every question there is about workers' compensation. We have experience in nearly every type of industry and region and provide the industry's broadest range of programs and services.

PRIMARY PURPOSE: To process low level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements with general supervision.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

  • Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.

  • Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.

  • Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.

  • Administers subrogation of claims and negotiates settlements.

  • Communicates claim action with claimant and client.

  • Ensures claim files are properly documented and claims coding is correct.

  • May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.

  • Maintains professional client relationships.

  • WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

  • Performs other duties as assigned.

  • Supports the organization's quality program(s).

  • Travels as required.

  • Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business

  • Excellent oral and written communication, including presentation skills

  • PC literate, including Microsoft Office products

  • Analytical and interpretive skills

  • Strong organizational skills

  • Good interpersonal skills

  • Ability to work in a team environment

  • Ability to meet or exceed Service Expectations

QUALIFICATION

Education & Licensing

Bachelor's degree from an accredited college or university preferred.

Experience

Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Claims Adjuster Workers Compensation

Gallagher Bassett NZ Ltd

Posted 6 days ago

VIEW JOBS 9/20/2022 12:00:00 AM 2022-12-19T00:00 <p>Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way.</p><p>Position Summary:</p><p>Investigates, evaluates, disposes and settles less complex claims with moderate supervision and includes the investigation, determination and evaluation of coverage, liability and damages and the setting of proper reserves. Incumbents at this level typically hold claims reserve and settlement authority of up to $5,000 liability and/or $10,000 workers compensation or greater.</p><p>Essential Duties &amp; Responsibilities:</p><ul><li><p>Exercises proper judgment and decision making to analyze the claims exposure to determine the proper course of action and to appropriately settle the claim.</p></li><li><p>Interacts extensively with various parties involved in the claim process.</p></li><li><p>Handles claims consistent with clients' and corporate policies, procedures and &quot;best practices&quot; and also in accordance with any statutory, regulatory and ethics requirements.</p></li><li><p>Documents and communicates all claim activity timely and effectively and in a manner which supports the outcome of the claim file.</p></li><li><p>Incumbents at this level should be able to work at full case load capacity.</p></li></ul><p>Additional Considerations:</p><p>Required:</p><ul><li><p>High School Diploma</p></li><li><p>Minimum of 3 years related claims experience required</p></li><li><p>Appropriately licensed and/or certified in all states in which claims are being handled.</p></li><li><p>Knowledge of accepted industry standards and practices.</p></li><li><p>Computer experience with related claims and business software.</p></li></ul><p>Desired:</p><ul><li>Bachelor's Degree</li></ul><p>Work Traits:</p><ul><li><p>Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges.</p></li><li><p>Analytical skill necessary to make decisions and resolve issues inherent in handling of claims.</p></li><li><p>Ability to successfully negotiate the settlement and disposition of claims including the ability to interpret related documentation.</p></li></ul><p>U.S. Eligibility Requirements:</p><ul><li><p>Interested candidates must submit an application and resume/CV online to be considered</p></li><li><p>Are you 18 years of age or older or can you demonstrate legal capacity to enter a contract?</p></li><li><p>Must be willing to submit to a background investigation; any offer of employment is conditioned upon the successful completion of a background investigation</p></li><li><p>Must have unrestricted work authorization to work in the United States. For U.S. employment opportunities, Gallagher hires U.S. citizens, permanent residents, asylees, refugees, and temporary residents. Temporary residence does not include those with non-immigrant work authorization (F, J, H or L visas), such as students in practical training status. Exceptions to these requirements will be determined based on shortage of qualified candidates with a particular skill. Gallagher will require proof of work authorization</p></li><li><p>Must be willing to execute Gallagher's Employee Agreement or Confidentiality and Non-Disclosure Agreement which requires, among other things, post-employment obligations relating to non-solicitation, confidentiality and non-disclosure</p></li></ul><p>Gallagher offers competitive salaries and benefits, including: medical/dental/vision plans, life and accident insurance, 401(K), employee stock purchase plan, educational expense reimbursement, employee assistance program, flexible work hours (availability varies by office and job function) training programs, matching gift program, and more.</p><p>Gallagher believes that all persons are entitled to equal employment opportunity and does not discriminate against nor favor any applicant because of race, sex, color, disability, national origin, religion, creed, age, marital status, citizenship, veteran status, gender, gender identity / expression, actual or perceived sexual orientation, or any other protected characteristic. Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified applicant with a disability, unless the accommodation would impose an undue hardship on the operation of our business.</p><p>#LI-Remote</p><p>#LI-AB2</p><br> Gallagher Bassett NZ Ltd Orange CA

Examiner Claims Associate Workers Compensation

Sedgwick Claims Management Services, Inc.