Workers Compensation Claims Examiner I
| Company | Sedgwick Claims Management Services |
|---|---|
| Location | Irvine, CA, USA |
| Salary | $71136 – $99500 |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Senior |
Requirements
- 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
- Subject matter expert of appropriate insurance principles and laws for line-of-business handled
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- 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
Responsibilities
- 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 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
Preferred Qualifications
- Professional certification as applicable to line of business preferred