Claims Examiner Workers Compensation
Company: Sedgwick
Location: Ontario
Posted on: February 25, 2021
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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.Claims Examiner Workers CompensationIF YOU
CARE, THERE'S A PLACE FOR YOU HEREFor a career path that is both
challenging and rewarding, join Sedgwick's talented team of 27,000
colleagues around the globe. Sedgwick is a leading provider of
technology-enabled risk, benefits and integrated business
solutions. Taking care of people is at the heart of everything we
do. Millions of people and organizations count on Sedgwick each
year to take care of their needs when they face a major life event
or something unexpected happens. Whether they have a workplace
injury, suffer property or financial loss or damage from a natural
or manmade disaster, are involved in an auto or other type of
accident, or need time away from work for the birth of a child or
another medical situation, we are here to provide compassionate
care and expert guidance. Our clients depend on our talented
colleagues to take care of their most valuable assets-their
employees, their customers and their property. At Sedgwick, caring
counts--. Join our team of creative and caring people of all
backgrounds, and help us make a difference in the lives of
others.For more than 50 years, Sedgwick has been helping employers
answer virtually every question there is about workers'
compensation. We have experience in nearly every type of industry
and region and provide the industry's broadest range of programs
and services.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.QUALIFICATIONEducation & LicensingBachelor's degree from
an accredited college or university preferred. Professional
certification as applicable to line of business
preferred.ExperienceFive (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 ExpectationsWORK
ENVIRONMENTWhen 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 deadlinesPhysical: Computer keyboarding, travel as
requiredAuditory/Visual: Hearing, vision and talkingNOTE: 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 is an Equal Opportunity Employer and a Drug-Free
Workplace.
Keywords: Sedgwick, Ontario , Claims Examiner Workers Compensation, Other , Ontario, California
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