Claims Examiner - Workers Compensation

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Claims Examiner - Workers Compensation

PRIMARY PURPOSE : To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.

• Supports other claims representatives examiners and leads with larger or more complex claims as necessary.

• Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy and files necessary documentation with state agency.

• Communicates claim action/processing with claimant client and appropriate medical contact.

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

• May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.

• Maintains professional client relationships.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.

• Supports the organization's quality program(s).

QUALIFICATION

Education & Licensing High school diploma or GED required. Licenses as required.

Experience One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.

Skills & Knowledge

• Excellent oral and written communication 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

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.