Claims Examiner II, Workers' Compensation – MEL00117

Description

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 recently voted the Best TPA in America 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 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:

1. Processes workers'' compensation claims determining compensability and benefits due on long-term indemnity claims; monitors reserve accuracy and files necessary documentation with state agency.
2. Develops and manages workers'' compensation claims action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
3. Manages subrogation of claims and negotiates settlements.
4. Communicates claim action/processing with claimant and client.
5. Maintains professional client relationships.
6. Maintains a quality assurance program to support the Total Performance Management initiative and the consistent delivery of quality claims service.

• Baccalaureate degree from an accredited college or university preferred
• Licenses as required

Experience: Two (2) years of Workers'' Compensation claims management experience required

Skills & Knowledge:

• Knowledge of ERISA regulations, offsets and deductions, disability duration, medical management practices and Social Security application procedures as applicable to Workers'' Compensation
• Excellent oral and written communication skills, including presentation skills
• PC literate, including Microsoft Office products
• Effective analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies