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Claims Examiner II - Workers' Compensation

CLAIM YOUR FUTURE AS A GREAT PERFORMER!

Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and 'Claim Your Future.'

PRIMARY PURPOSE : To analyze mid and higher-level workers compensation, general liability or disability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to manage subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Processes general liability claims by gathering information to determine liability exposure, assigns reserve values to claims, making claims payments as necessary and settling claims up to designated authority level.

Processes 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 disability claims, determines benefits due, and manages action plan pursuant to the disability claim or client contract.

Manages subrogation of claims and negotiates settlements.

Communicates claim action/processing with claimant and client.

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

Maintains professional client relationships.

Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing
Baccalaureate degree from an accredited college or university preferred. Licenses as required.

Experience
Two (2) years of claims management experience or successful completion of Claims Examiner II training required.

Skills & Knowledge

• Knowledge of ERISA regulations, offsets and deductions, disability duration, medical management practices and Social Security 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

  
  

• Ability to work in a team environment

  
  

• Ability to meet or exceed Performance Competencies

  
  

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 .

Sedgwick CMS is an Equal Opportunity Employer

and a

Drug-Free Workplace

Additional Information: Workers' Compensation claims handling experience in the Washington jurisdiction required.

WA workers' compensation licensing preferred.
Requisition #: 7892

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