Workers Compensation Claims Examiner

This is a fully remote position, open to applicants in Connecticut, +6 more states.

📋 Description

• Evaluate lost-time workers' compensation claims for clients to ascertain entitled benefits.

• Maintain ongoing adjudication of claims within service expectations, industry standards, and client needs.

• Investigate claims and collect information to assess claim exposure.

• Manage claims through action plans aimed at achieving appropriate and timely resolutions.

• Negotiate claim settlements within the established authority limits.

• Communicate claim progress and processing status with both claimants and clients.

• Report claims to excess insurance carriers.

• Respond to directional requests in a professional and timely manner.

• Utilize Sedgwick's global network of experts to acquire and disseminate insights.

• Provide customer-facing solutions to clients across various industries.

⛳️ Requirements

• A High School Diploma or GED is required.

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

• Professional certification relevant to the line of business is preferred.

• A minimum of 5 years of claims management experience or an equivalent combination of education and experience is required.

• Familiarity with workers' compensation jurisdictions: MA, CT, NH, RI, VT.

• Licensing required in VT, CT, NH, and RI.

• Capability to analyze and process lost-time workers' compensation claims.

• Proficiency in investigating claims and gathering information to determine exposure.

• Ability to negotiate claim settlements within designated authority limits.

• Skill in communicating claim activity with claimants and clients.

• Competence in reporting claims to excess carriers and responding to direction requests.

• Strong analytical and conceptual thinking abilities.

• Excellent judgment, troubleshooting, problem-solving, analysis, and discretion.

• Capacity to manage work-related stress and multiple priorities.

• Ability to meet deadlines consistently.

• Proficient in computer keyboarding.

• Ability to hear, see, and communicate effectively.

🏝️ Benefits

• Flexible work schedule.

• Referral incentive program.

• Opportunity to thrive in an agile environment.

• Career development and promotional growth opportunities.

• Medical, dental, and vision insurance.

• 401K with matching contributions.

• Paid Time Off (PTO).

• Disability and life insurance.

• Employee assistance program.

• Flexible spending or health savings account.

• Additional voluntary benefits available.

• Remote work flexibility and autonomy.