Claims Examiner - Workers Compensation (REMOTE- Southeast State experience)

Sedgwick • Knoxville, TN • 5h ago

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.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Claims Examiner - Workers Compensation (REMOTE- Southeast State experience)

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.

Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world's most respected organizations.

Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.

Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights.

Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.

Enjoy flexibility and autonomy in your daily work, your location, and your career path.

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

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 : 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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.

Supports the organization's quality program(s).

Travels as required.

QUALIFICATIONS

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.

TAKING CARE OF YOU

Flexible work schedule.

Referral incentive program.

Career development and promotional growth opportunities.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

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.

Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com

Similar Jobs

ACCOUNTANT-SENIOR

Covenant Health Inc. • Knoxville, TN • 1h ago

Finance, Accounting & Banking

Overview Senior Accountant, Accounting & Finance Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's top-performing healthcare network with 10 hospitals, outpatient...

1h ago

Go to Apply

Internship - Accounting

Waste Connections • Knoxville, TN • 2d ago

Finance, Accounting & Banking

About Us WASTE CONNECTIONS, Inc. (NYSE: WCN): is a non-hazardous solid waste services company that provides solid waste collection, transfer, disposal, and recycling services in the U.S. and Canada. Our employees foster...

2d ago

Go to Apply

Accounts Payable / Administrative Assistant

Aston Carter • Knoxville, TN • 3d ago

Finance, Accounting & Banking

We are a Municipal Utility Contractor specializing in Water and Wastewater Utility Construction. We are seeking an experienced Accounts Payable / Administrative Assistant to join our team and provide essential support to...

3d ago

Go to Apply

Accounts Payable / Administrative Assistant

Aston Carter • Knoxville, TN • 3d ago

Finance, Accounting & Banking

3d ago

Go to Apply

Accounts Payable Specialist

Aston Carter • Knoxville, TN • 4d ago

Finance, Accounting & Banking

Description Municipal Utility Contractor specializing in the Water Wastewater Utility Construction currently has an open position for an Accounts Payables/Administrative Assistant. The position provides overall administr...

4d ago

Go to Apply

Accounts Payable Associate

Aston Carter • Knoxville, TN • 4d ago

Finance, Accounting & Banking

Accounts Payable Clerk Description A company in Knoxville, TN, currently has an open position for an Accounts Payables/Administrative Assistant. The position provides overall administrative support for the Accounting Dep...

4d ago

Go to Apply

Middle Market Banking & Specialized Industries, Relationship Manager/Banker Executive Director

JPMorgan Chase • Knoxville, TN • 6d ago

Finance, Accounting & Banking

In this role you will be the focal point of client acquisition and ongoing relationships. Bankers work both independently and as part of a team to introduce our comprehensive solutions to clients. As a Banker, you will b...

6d ago

Go to Apply

Accounting Clerk

Robert Half • Knoxville, TN • 6d ago

Finance, Accounting & Banking

Description Our client in the government industry is seeking a highly detail-oriented Accounting Specialist to join their team in Oak Ridge, TN. This role is ideal for professionals with experience in government accounti...

6d ago

Go to Apply

Auditor

Contact Government Services, LLC • Knoxville, TN • 6d ago

Finance, Accounting & Banking

Auditor Employment Type: Full-Time, Experienced Department: Financial CGS is seeking a highly skilled Senior Auditor to provide general auditing and accounting services in support of fraud investigations involving potent...

6d ago

Go to Apply

Teller

First Horizon Bank • Alcoa, TN • 1w ago

Finance, Accounting & Banking

Description Location : On site at location listed in job posting. Summary : Provide quality, accurate and timely customer service involving daily processing of financial transactions in a retail banking environment. Ofte...

1w ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.