Claims Examiner - Workers Compensation | Jurisdiction: TX | Licensing: TX Required

PRIMARY PURPOSE OF THE ROLE:

We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

About the Role

Join Sedgwick, a global industry leader, where you can bring your big ideas to help solve problems for some of the world’s best brands. As a Claims Examiner for Workers’ Compensation in Texas, you’ll be part of a dynamic team working with high-exposure claims involving litigation and rehabilitation.

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 claims within designated authority level;
• Prepares necessary state filings 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;
• Performs other duties as assigned;
• Supports the organization's quality program(s).

Qualifications

• Education and Licensing: Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certifications as applicable to line of business preferred.
• Experience: Five (5) years of claims management experience or equivalent combination of education and experience required. Jurisdiction/Licensing: TX

Benefits

• Flexible work schedule.
• Referral incentive program.
• Opportunity to work in an agile environment.
• Career development and promotional growth opportunities.
• A diverse and comprehensive benefits offering including medical, dental, vision, 401K on day one.