RiversideRecruiter Since 2001
the smart solution for Riverside jobs

Claims Examiner Workers Compensation

Company: Sedgwick
Location: Riverside
Posted on: August 14, 2019

Job Description:

Claims Examiner Workers Compensation

IF YOU CARE, THERE'S A PLACE FOR YOU HERE

For a career path that is both challenging and rewarding, join Sedgwick's talented team of 21,000 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 nearly 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, in every region, providing the 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.

      QUALIFICATION

      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.

      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
      • Excellent interpersonal skills
      • Excellent negotiation skills
      • Ability to work in a team environment
      • Ability to meet or exceed Service Expectations

        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 is an Equal Opportunity Employer

        and a

        Drug-Free Workplace

        **Must currently meet the requirements for designation under AB1262, or have California Self-Insurers Certificate (SIP) or AB1262 California Experienced Examiner Designation. WCCA, WCCP preferred.

        #LI-TS

Keywords: Sedgwick, Riverside , Claims Examiner Workers Compensation, Other , Riverside, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


School Based MFLC Counselor
Description: Position Purpose: -The Counselor is a licensed mental health professional who exercises discretion and independent judgment to provide appropriate information, coaching, training, and education concerning (more...)
Company: Centene Corporation
Location: National City
Posted on: 08/21/2019

Postmates Part Time Delivery Driver (Supplement Your Income)
Description: Postmates uses technology to connect local businesses with people around the city. Our fleet receives requests through the app, and delivers anything from anywhere, 24/hrs a day. We are
Company: Postmates
Location: Altadena
Posted on: 08/21/2019

Pharmacy Tech I Part Time
Description: SummaryThe individual in this position will assist in preparing, packaging, delivering, and charging of medications, under the direct supervision of a
Company: Tenet
Location: Palm Springs
Posted on: 08/21/2019


Get New Contractor Work Today - Preview Leads In Your Area
Description: Over 25 million homeowners have trusted HomeAdvisor 1800Contractor to help them find quality professionals with the expertise to turn their home improvement
Company: HomeAdvisor
Location: San Clemente
Posted on: 08/21/2019

Drive with Lyft - No car needed.
Description: What is Lyft br Lyft matches drivers with passengers who request rides through the Lyft smartphone app. Signing up to br be a Lyft driver is the perfect opportunity for you to set your own schedule (more...)
Company: Lyft
Location: Altadena
Posted on: 08/21/2019

91J Quartermaster and Chemical Equipment Repairer
Description: The Army National Guard uses a wide range of systems that help protect and serve the force, and as a Quartermaster and Chemical Equipment Repairer, you'll be in charge of making sure those systems keep (more...)
Company: Army National Guard
Location: Burbank
Posted on: 08/21/2019

UI/UX Designer
Description: Job ID br br 2019-11249 br br OVERVIEW br br Join our team and discover new ways of solving complex business problems while still meeting the needs of our end users. Work with top consultants (more...)
Company: Esri
Location: Redlands
Posted on: 08/21/2019

EPA CERTIFIED SEALED SYSTEMS APPLIANCE TECH! Start immediately!
Description: Puls is seeking motivated Appliance repair technicians who specialize in refrigeration are interested in unlimited earning
Company: Puls
Location: Burbank
Posted on: 08/21/2019

Postmates Delivery Driver (Make Your Own Schedule)
Description: Postmates uses technology to connect local businesses with people around the city. Our fleet receives requests through the app, and delivers anything from anywhere, 24/hrs a day. We are
Company: Postmates
Location: National City
Posted on: 08/21/2019

Postmates Delivery Driver (No Experience Needed)
Description: Postmates uses technology to connect local businesses with people around the city. Our fleet receives requests through the app, and delivers anything from anywhere, 24/hrs a day. We are
Company: Postmates
Location: Cathedral City
Posted on: 08/21/2019

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Riverside RSS job feeds