Claims Examiner I
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choicedesignation. Come be a part of our team and 'Claim Your Future.'
PRIMARY PURPOSE: To analyze reported lower-level workers compensation, general liability or disability claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision. Handles lower-level liability and/or physical damage claims or disability claims of minimal disability duration under close supervision. Supports other claims examiners and claims supervisors with larger or more complex claims as necessary. Processes general liability claims by gathering information to determine liability exposure, assigns reserve values to claims, making claims payments as necessary and settling claims up to the designated authority level. Processes workers compensation claims determining compensability and benefits due, monitors reserve accuracy and files necessary documentation with state agency. Processes assigned disability claims and determines benefits due pursuant to the disability plan or client contract, and makes timely claims payments and adjustments. Communicates claim action/processing with claimant, client, and appropriate medical contact. Ensures claim files are properly documented and claims coding is correct. Maintains professional client relationships. Supports the total performance management initiative.
QUALIFICATIONS
Education & Licensing
High school diploma or GED required. Licenses as required.
Experience
One (1) year of general office experience required. Claims industry experience preferred. Any college degree may be substituted for the required experience.
Skills & Knowledge Excellent oral and written communication PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Good interpersonal skills Ability to work in a team environment Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment 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 CMS is an Equal Opportunity Employer and a Drug-Free Workplace
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