Claims Examiner - Workers Comp | Jurisdiction: AL, FL, GA, MS, NC, SC, TN | Licensing: Home State Required

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

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Claims Examiner - Workers Comp | Jurisdiction: AL, FL, GA, MS, NC, SC, TN | Licensing: Home State Required

Apply your Workers Compensation & supervisory knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.  

Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations. 

ARE YOU AN IDEAL CANDIDATE? To analyze complex or technically difficult general liability claims to determine benefits due; to work with high exposure liability claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; to identify subrogation of claims and negotiate settlements; and to provide backup for team lead when out of the office. 

 

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. 

 

 

ESSENTIAL RESPONSIBLITIES MAY INCLUDE 

• Analyzes and processes complex or technically difficult general liability 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. 

• Manages the litigation process; ensures timely and cost-effective claims resolution. 

• Coordinates vendor referrals for additional investigation and/or litigation management. 

• Leads team meetings and assigns accountability for follow-up items. 

• Gathers important compliance/claims processing information to be presented at team meetings. 

• Assists in interviews of adjusters, clerical staff and provides feedback to hiring manager. 

• Provides limited assistance/support to team lead with monthly review of adjuster workloads; notes trends and suggests adjustments when necessary. May include up to (3) three direct reports. 

 

SUPERVISORY RESPONSIBILITIES 

• Administers company personnel policies in all areas and follows company staffing standards and training recommendations. 
• Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions. 
• Provides support, guidance, leadership, and motivation to promote maximum performance. 

 

QUALIFICATIONS  

Education & Licensing: 5 years of claims management experience or equivalent combination of education and experience required. 

High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.  

Professional certification as applicable to line of business preferred. 

 

Jurisdiction Knowledge: Nationwide 

Licensing: Home State Required 

 

TAKING CARE OF YOU  

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. 

 

 

WORK ENVIRONMENT REQUIREMENTS INCLUDE   
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 

Auditory/Visual: Hearing, vision and talking  

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($63,00.00 - 88k). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

#claimsexaminer #claims #hybrid #LI-REMOTE 

 

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.