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Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick has a strong commitment to its colleagues and its clients. If you are seeking a place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick is the place for you. As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as the Best TPA in America and the coveted Employer of Choice designation, we invite you to come be a part of our team and, "Claim Your Future."
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.
This position is done for the purpose/s of managing the development and implementation of safety and health programs and monitors loss control services to participating school districts. ESD 113 is a great employer and provides generous employee benefits including health and retirement benefits through the Washington State employee programs.
Penser North America’s Self Insured
Workers Compensation department, located in Lacey, Washington has an opening
for a Claims Examiner. This is a non-union, salaried, administrative, full time
position for self-insured Workers compensation claims handling at this Third
• 2 year college degree or equivalent experience
• 3-5 years Workers Compensation claims experience
• Must possess working knowledge of applicable workers Comp laws, rules and regulations.
• Strong investigative, decision making and problem solving abilities.
• Excellent oral and written communications skills.
• Superior analytical and negotiation skills.
• Computer proficiency with basic claims system and Microsoft Office.
• Washington Self Insurance certification is preferred.
• Detail oriented, organized individual with the ability to work in team environment
• Ability to multi-task, meet tight deadline and shift priority workloads
• High degree of integrity and confidentiality required
• Must be self-motivated, detail oriented and able to maintain current diaries
• Familiarity with medical codes,
terminology, medical aid rules and fee schedule
• Ability to set and adjust reserves, monitor and manage third party claims, and vocational rehabilitation claims
KEY RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO:
•Investigate, evaluate, and adjudicate Workers compensation claims to their conclusion.
• Coordinates referrals and manage, Nurse Case managers, Vocational rehab, and attorneys
• Calculate time loss and ensure timely and accurate delivery of benefits to injured workers.
• Review provider billing for payment, investigate and respond to inquiries from providers.
• Maintain communication with injured workers, employers, medical providers.
• Manage litigated cases, answer legal requests, attend hearings, and mediations.
• Manages claim recoveries, including Second Injury Fund, excess recoveries and Social Security offsets
• Reports claims to the excess carrier; responds to requests for information in a professional and timely manner
• Maintain correct and adequate documentation of claim management in claim system.
SALARY: Salary will be commensurate with experience qualifications.