Claims Adjuster - Workers Compensation
Company: Sedgwick
Location: San Antonio
Posted on: January 27, 2023
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 Adjuster - Workers CompensationIF YOU
CARE, THERES A PLACE FOR YOU HEREFor a career path that is both
challenging and rewarding, join Sedgwicks 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 assetstheir
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 industrys 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.QUALIFICATIONEducation &
LicensingBachelor's degree from an accredited college or university
preferred. Professional certification as applicable to line of
business preferred.ExperienceFive (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
- Good interpersonal skills
- Excellent negotiation skills
- Ability to work in a team environment
- Ability to meet or exceed Service ExpectationsWORK
ENVIRONMENTWhen 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 deadlinesPhysical: Computer keyboarding, travel as
requiredAuditory/Visual: Hearing, vision and talkingNOTE : 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.Taking care of people is at the heart of everything we
do. Caring countsSedgwick is a leading global provider of
technology-enabled risk, benefits and integrated business
solutions. Every day, in every time zone, the most well-known and
respected organizations place their trust in us to help their
employees regain health and productivity, guide their consumers
through the claims process, protect their brand and minimize
business interruptions. Our more than 30,000 colleagues across 80
countries embrace our shared purpose and values as they demonstrate
what it means to work for an organization committed to doing the
right thing one where caring counts. Watch this video to learn more
about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)
Keywords: Sedgwick, San Antonio , Claims Adjuster - Workers Compensation, Other , San Antonio, Texas
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