Claims Examiner
Company: Sedgwick
Location: Rancho Cordova
Posted on: January 27, 2023
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Job Description:
**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.**Taking care of people is at
the heart of everything we do, and we start by taking care of you,
our valued colleague. A career at Sedgwick means experiencing our
culture of caring. It means having flexibility and time for all the
things that are important to you. It's an opportunity to do
something meaningful, each and every day. It's having support for
your mental, physical, financial and professional needs. It means
sharpening your skills and growing your career. And it means
working in an environment that celebrates diversity and is fair and
inclusive.A career at Sedgwick is where passion meets purpose to
make a positive impact on the world through the people and
organizations we serve. If you are someone who is driven to make a
difference, who enjoys a challenge and above all, if you're someone
who cares, there's a place for you here. Join us and contribute to
Sedgwick being a great place to work.Great Place to Work -Most
Loved Workplace -Forbes Best-in-State EmployerClaims
Examiner**PRIMARY PURPOSE** : To analyze complex or technically
difficult workers' compensation claims to determine benefits due;
to work with high exposure claims involving litigation and
rehabilitation; to ensure ongoing adjudication of claims within
service expectations, industry best practices and specific client
service requirements; and to identify subrogation of claims and
negotiate settlements.**ESSENTIAL FUNCTIONS and RESPONSIBILITIES**+
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.**ADDITIONAL FUNCTIONS and
RESPONSIBILITIES**+ Performs other duties as assigned.+ Supports
the organization's quality program(s).+ Travels as
required.**QUALIFICATION****Education & Licensing**Bachelor's
degree from an accredited college or university preferred.
Professional certification as applicable to line of business
preferred.**Experience**Five (5) years of claims management
experience or equivalent combination of education and experience
required.**Skills & Knowledge**+ 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.+ 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**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.The statements contained in
this document are intended to describe the general nature and level
of work being performed by a colleague assigned to this
description. They are not intended to constitute a comprehensive
list of functions, duties, or local variances. Management retains
the discretion to add or to change the duties of the position at
any time.\#ClaimsExaminerSedgwick is an Equal Opportunity Employer
and a Drug-Free Workplace.**If you're excited about this role but
your experience doesn't align perfectly with every qualification in
the job description, consider applying for it anyway! Sedgwick is
building a diverse, equitable, and inclusive workplace and
recognizes that each person possesses a unique combination of
skills, knowledge, and experience. You may be just the right
candidate for this or other roles.****Taking care of people is at
the heart of everything we do. Caring counts**Sedgwick is a leading
global provider of technology-enabled risk, benefits and integrated
business solutions. Every day, in every time zone, the most
well-known and respected organizations place their trust in us to
help their employees regain health and productivity, guide their
consumers through the claims process, protect their brand and
minimize business interruptions. Our more than 30,000 colleagues
across 80 countries embrace our shared purpose and values as they
demonstrate what it means to work for an organization committed to
doing the right thing - one where caring counts. Watch this video
to learn more about us.
(https://www.youtube.com/watch?v=ywxedjBGSfA)
Keywords: Sedgwick, Rancho Cordova , Claims Examiner, Other , Rancho Cordova, California
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