Claims examiner Jobs in Cary, NC

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

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Claims Adjuster - Workers Compensation | Jurisdiction: MI, TX, IN, IL, OH | Licensing: Required - Remote

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?

• Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

PRIMARY PURPOSE OF THE ROLE: To analyze mid- and higher-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.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

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

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

• Manages 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 complex 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.

QUALIFICATIONS

Education and Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience

Four (4) years of claims management experience or equivalent combination of education and experience required.

Jurisdiction Knowledge: MI, TX, IN, IL, OH

Licensing: Home State Required

TAKING CARE OF YOU

• 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.

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

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.

Sedgwick 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.