Claims Examiner - Long Shore and Harbor Workers Compensation (Remote)

Company: Sedgwick Claims Management Services, Inc.
Location: Hampton
Posted on: November 20, 2022

Job Description:

The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.

Claims Examiner - Long Shore and Harbor Workers Compensation (Remote)

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 27,000 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 more than 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 and region and provide the industry's broadest range of programs and services.

We're growing! If you are an experienced US Long Shore and Harbor Workers claim professional, we may have the opportunity you're looking for. To be considered for a full-time remote position, must have a minimum of three (3) years of experience handling Long Shore and Harbor Workers Compensation Act claims or claims arising under the Defense Base Act. We're also accepting applications for local candidates with transferable Workers Compensation Claim Handling Skills.

Primary Purpose:

To analyze workers' compensation claims to determine benefits due under the Long Shore and Harbor Workers Compensation Act. 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 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 federal 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.
* Supports the organization's quality program(s).
* Performs other duties as assigned.

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. To be considered for a full-time remote position, must have a minimum of three (3) years of experience in handling Long Shore and Harbor Workers Compensation Act claims or claims arising under the Defense Base Act.

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.
* Excellent oral and written communication, including presentation skills
* PC literate, including Microsoft Office products
* Analytical and interpretive skills
* Strong organizational skills
* Good 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.

Keywords: Sedgwick Claims Management Services, Inc., Hampton , Claims Examiner - Long Shore and Harbor Workers Compensation (Remote), Other , Hampton, Virginia