Job Closed

This listing is no longer active.

Sedgwick logo
Sedgwick

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.

Claims Examiner – Workers Comp

Claims SpecialistClaims SpecialistFull TimeRemoteSeniorTeam 10,001+H1B SponsorCompany SiteLinkedIn

Location

Connecticut + 7 moreAll locations: Connecticut | District Of Columbia | New Hampshire | Massachusetts | Rhode Island | Vermont | Virginia | West Virginia

Posted

68 days ago

Salary

$60.2K - $90K / year

Seniority

Senior

Bachelor Degree5 yrs expEnglish

Job Description

Claims Examiner – Workers Comp

Sedgwick

• 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 • To identify subrogation of claims and negotiate settlements • 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 claims within designated authority level • Prepares necessary state filings 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 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 for directions in a professional and timely manner • Communicates claim activity and processing with the claimant and client; maintains professional client relationships • Ensures claim files are properly documented and claims coding is correct • Refers cases as appropriate to supervisor and management.

Job Requirements

  • Bachelor's degree from an accredited college or university preferred
  • Professional certification as applicable to line of business preferred
  • Jurisdiction licensing needed: NH, VT, MA, CT, RI, DC, DE, WV, VA
  • Five (5) years of claims management experience or equivalent combination of education and experience required
  • 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 Expectations.

Benefits

  • medical
  • dental
  • vision
  • 401k and matching
  • PTO
  • disability and life insurance
  • employee assistance
  • flexible spending or health savings account
  • other additional voluntary benefits

Related Categories

Related Job Pages

More Claims Specialist Jobs

Nationwide Insurance logo

Field Claims Adjuster III, PL Property (Flex Team)

Nationwide Insurance

Nationwide Insurance, founded in 1926, is one of the oldest and most well-respected insurance agencies in the United States. Headquartered in Columbus, Ohio, where more than 10,000

If you’re passionate about helping people protect what matters most to them at a Fortune 100 company with nearly $70 billion in annual sales, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers and partners are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care. This position is designated to provide critical support to the Field Property Claims Team. The role requires a high level of flexibility, with travel expectations of up to 80% depending on business needs. The individual will be deployed to assist in maintaining operational continuity, ensuring service quality, and supporting team performance across various regions. Assignments may vary in duration and location, and the ability to quickly adapt to new environments and team dynamics is essential. Ideal candidates for this role will be located in the following territories: - Dallas, TX - South Central US (Memphis, TN, Nashville, TN, Birmingham, AL) - North Eastern/Mid Atlantic US Qualifications: · 5 years of insurance field/property claims handling or adjusting experience · Solid experience/proficiency with Xactimate · Solid experience writing own estimates and handling claims start to finish · Strong customer service competency · Strong written & verbal communication skills Flex team associates may receive a $100 daily bonus, plus per diem, for each workday spent deployed outside their normal territory, requiring an overnight hotel stay of three or more nights. This applies to standard (non-catastrophe) deployments involving travel of 50+ miles from home or work. Deployments may require multiple-day stays depending on business needs. PLEASE NOTE that CAT duty is required for this position. Benefits Include: Medical, Dental, Vision, 401k with company match, Company-paid Pension plan, Paid time off and more. Job Description Summary No two property claims are ever the same and each customer has unique needs. Our team thrives on providing the very best service and building lasting, successful relationships with our customers. If you are confident, curious, driven to learn and grow, and have a desire to help people when they most need it, we want to know more about you! As a Field Claims Specialist, you'll resolve serious exposure claims requiring investigation, liability evaluation and negotiation. We'll count on you to expedite settlements and control average loss cost and litigation expense according to the best claims practices. Job Description Key Responsibilities: - Handles all assigned claims promptly and effectively, with little direction and oversight, which may include complex and catastrophic losses. Makes decisions within delegated authority, recommends settlement values in the disposition of claims as outlined in company policies and procedures. - Determines proper policy coverages and applies standard methodologies to conclude assigned cases according to company guidelines. Adheres to high standards of professional conduct while delivering outstanding service. - Opens, closes and adjusts reserves according to company practices to ensure reserve adequacy. Adheres to file conferencing notification and authority procedures. - Maintains current knowledge of assigned insurance lines; court decisions which may impact the claims function; current guidelines; and policy changes and modifications. This may require attending various seminars or training sessions. - Maintains current knowledge of local industry repair procedures and local market pricing. - Able to act for the Claims Manager. Mentors and provides leadership to less experienced claims associates. Provides one-on-one training and helps with training/presentations as assigned by claims management. - Partners with Special Investigation Unit and Subrogation to identify fraud and subrogation opportunities. Assists or prepares files for suit, trial or subrogation. - Initiates and conducts follow-ups through proficient use of the claims and other related business systems. - Delivers an outstanding customer service experience to all internal, external, current and prospective Nationwide customers. May perform other responsibilities as assigned. Reporting Relationships: Reports to Claims Manager. Individual contributor role. Typical Skills and Experiences: Education: Undergraduate studies in business administration or related field preferred and/or validated experience License/Certification/Designation: Successful completion of required claims certification schools or courses. Professional development such as IIA or CPCU preferred. State licensing where required. Obtain Xactimate Level 1 certification within a year of start date. Obtain Xactimate Level 2 certification within two years of employment. Experience: Five years of experience handling property claims, insurance processing or field claims adjusting. Knowledge, Abilities and Skills: General knowledge of insurance theory and practices, and contracts and their application. Property estimating and automated claims systems. Demonstrated knowledge of the investigation, consultation and settlement activities used to resolve extensive property damage claims. Proven ability to meet customer needs and provide exemplary meaningful service by guiding customers through the claims process and ensuring a positive customer experience. Analytical and problem-solving skills necessary to make decisions and resolve issues related to application of coverages to submitted claims, application of laws of jurisdiction to investigation facts, and application of policy exclusions and exceptions. Ability to establish repair requirements and cost estimates for property losses. Ability to evaluate and successfully advise on property claims. Organizational skills to prioritize work. Command of written and verbal communication skills to effectively communicate with policyholders, claimants, repairpersons, attorneys, agents and the general public. Ability to efficiently operate a personal computer and related claims and business software. Able to provide leadership to less experienced claims associates. Must be able to safely access and inspect rooftops using a ladder.  Must be prepared and capable of conducting physical inspections on rooftops, including first and second story roofs with pitches up to 8/12. Other criteria, including leadership skills, competencies and experiences may take precedence. Staffing exceptions to the above must be approved by the business unit executive and HR Business Partner. Values: Regularly and consistently demonstrates the Nationwide Values. Job Conditions: Overtime Eligibility: Not Eligible (Exempt) Working Conditions: Normal office or field claims environment. May require ability to sit and operate phone and personal computer for extended periods of time. Able to make physical inspections of property loss sites; including climb ladders, balance at various heights and rooftops up to 8/12 pitch stoop, bend and/or crawl to inspect vehicles and structures; work outside in all types of weather. Must be willing to work irregular hours and to travel with possible overnight requirements. May be on-call. Must be available to work catastrophes (CAT). Extended and/or non-standard hours as required. Must have a valid driver’s license with satisfactory driving record in accordance with Nationwide standards.  ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties. Credit/Background Check: Due to the fiduciary accountability within this job, a valid credit check and/or background check will be required as part of the selection process. Benefits We have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more. To learn more about the benefits we offer, click here. Nationwide is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive culture where everyone feels challenged, appreciated, respected and engaged. Nationwide prohibits discrimination and harassment and affords equal employment opportunities to employees and applicants without regard to any characteristic (or classification) protected by applicable law. #claims For NY residents please review the following state law information: Notice of Employee Rights, Protections, and Obligations LS740 (ny.gov) https://dol.ny.gov/system/files/documents/2022/02/ls740_1.pdf NOTE TO EMPLOYMENT AGENCIES: We value the partnerships we have built with our preferred vendors. Nationwide does not accept unsolicited resumes from employment agencies. All resumes submitted by employment agencies directly to any Nationwide employee or hiring manager in any form without a signed Nationwide Client Services Agreement on file and search engagement for that position will be deemed unsolicited in nature. No fee will be paid in the event the candidate is subsequently hired as a result of the referral or through other means. Nationwide pays on a geographic-specific salary structure and placement within the actual starting salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity and location of the role as well as the cost of labor in the market; and other conditions of employment. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range. Note on Compensation for Part-Time Roles: Please be aware that the salary ranges listed below reflect full-time compensation. Actual compensation may be prorated based on the number of hours worked relative to a full-time schedule. The national salary range for Field Claims Specialist III, Property : $79,500.00-$148,500.00 The expected starting salary range for Field Claims Specialist III, Property : $79,500.00 - $119,500.00

United States + 1 moreAll locations: United States | United Kingdom
$79.5K - $148K / year
AXA logo

Schadenregulierer Großraum Offenburg (m/w/d)

AXA

AXA is a leading provider of wealth management, financial protection, and global insurance services for millions of clients nationwide. A French, multinational

Full TimeRemoteTeam 10,001

Du bist gerne bei Kund:innen und siehst dich als Problemlöser:in und wohnst idealerweise in Offenburg und Umgebung, dann bewerbe dich jetzt: Das erwartet dich - Bei Schäden aus dem Geschäftsbereich Sachversicherung entscheidest Du, wie dem Kunden am besten geholfen werden kann. Neben einer Vorortbesichtigung kann auch eine Betreuung des Schadens vom Schreibtisch aus erfolgreich sein. - Du verhandelst gekonnt mit den Beteiligten, koordinierst die notwendigen Maßnahmen und begleitest den Kunden bis zum Abschluss des Schadens. - Mit Deinem Dienstwagen besichtigst Du die Schadenorte und nimmst den Schaden mit Deinem iPad auf – Übrigens: den Dienstwagen kannst Du auch privat nutzen. - In einem eigenen Campus für den Schadenaußendienst wirst Du von Kolleg:innen in allem, was Du für den Job brauchst, fit gemacht. - Später arbeitest Du eigenständig und teilst Dir Deine Arbeitszeit selbst ein, denn Du arbeitest von Deinem Wohnort aus im gesuchten Gebiet und fährst dorthin, wo Du gebraucht wirst. - Du nimmst an Projekten teil, kannst an übergreifenden Aufgaben des Bereichs mitarbeiten und Dich immer einbringen. - Mit Deinem Team bist Du vernetzt, knüpfst aber auch Kontakte über den eigenen Bereich hinaus. Das bringst du mit - Du hast eine abgeschlossene kaufmännische Ausbildung, bist Kauffrau/-mann für Versicherungen und Finanzen oder sogar Versicherungsfachwirt:in? - Du konntest bereits Erfahrungen als Schadenregulierer:in sammeln oder hast Schäden als Projektleiter:in bei einem Sanierer verantwortet? - Du verstehst Dich als Dienstleister:in und Problemlöser:in für unsere Kunden? - Du besitzt umfassende Kenntnisse in der Bearbeitung von Sachschäden? - Du arbeitest gerne selbstorganisiert und bildest Dich eigenständig weiter? Das bieten wir dir - Arbeitszeit: Vertrauensarbeitszeit, du organisierst deinen Tagesablauf und Termin selbständig - Freizeit: 30 Tage Urlaub, extra freie Tage an Silvester und Heiligabend sowie Sonderurlaub für besondere Anlässe - Bewegung: Bezuschusstes Fitnessangebote, Betriebssportverein und betriebliches Gesundheitsmanagement - Vorsorge: Betriebliche Altersvorsorge, Vermögenswirksame Leistungen, Möglichkeit AXA-Aktionär zu werden sowie vergünstigte Mitarbeiter-Tarife für Versicherungen - Finanzielle Vorteile: Weihnachtsgeld & Urlaubsgeld, Erfolgsbeteiligung und Rabatt auf zahlreiche bekannte Brands und Technik - Mobilität: Dienstwagen - Entwicklung: Entwicklungsprogramme, E-Learning, Coaching und Mitarbeitergespräche sowie Weiterbildungen Bock auf Neues? Bock auf AXA! Susana Moraga freut sich auf deine Bewerbung. Für Fragen steht dir unser Recruiting-Team zur Verfügung. Du erreichst uns unter recruiting@axa.de. Du möchtest noch mehr über AXA als Arbeitgeber erfahren und tiefer in unsere Arbeitswelten eintauchen? Dann bist du auf unserer Karriereseite genau richtig! Über AXA AXA Deutschland ist Teil der AXA Gruppe, einem der weltweit führenden Versicherungsunternehmen mit Schwerpunkten in Europa, Nordamerika und dem asiatisch-pazifischen Raum. Als einer der größten Erstversicherer in Deutschland betreuen wir rund 8 Millionen Kund:innen im Bereich Vorsorge und Versicherung. Was uns bei AXA antreibt? Unsere Neugier und unser Mut zur Innovation! Gemeinsam mit über 8.000 Kolleg:innen in ganz Deutschland gestalten wir die Zukunft der Versicherung aktiv mit. Wir sind auf der Suche nach kreativen und analytischen Köpfen, die sich auch von Herausforderungen nicht beirren lassen. Bei uns erwartet dich ein Umfeld, in dem Ideen und Feedback auf offene Ohren treffen, Projekte schnell ins Rollen kommen und „monoton“ ein Fremdwort ist. Wir pflegen eine Kultur der Offenheit und Wertschätzung und begrüßen Vielfalt in all ihren Formen. Wir sind Menschen mit Ecken und Kanten, die ohne Berührungsängste aufeinander zugehen. Bei AXA empfangen wir dich mit offenen Armen unabhängig von Geschlecht, Herkunft, sexueller Orientierung, einer Behinderung oder anderen Facetten. #LI-DNP

Germany
Job Closed
Sedgwick logo

Workers Compensation Claims Examiner | NJ, PA, VA, DE Jurisdictions

Sedgwick

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.

Full TimeRemoteTeam 10,001+H1B Sponsor

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. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Workers Compensation Claims Examiner | NJ, PA, VA, DE Jurisdictions Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands? - Apply your 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. - Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. - Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights. - Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. - Enjoy flexibility and autonomy in your daily work, your location, and your career path. - Access diverse and comprehensive benefits to take care of your mental, physical, financial, and professional needs. ARE YOU AN IDEAL CANDIDATE? To analyze Lost-Time Workers Compensation (litigated, subrogation, high exposure/severe cases) claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. 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 - Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim. - Negotiating settlement of claims within designated authority. - Communicating claim activity and processing with the claimant and the client. - Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner. QUALIFICATIONS - Education & Licensing: 2-3 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: NJ, PA, VA, DE Licensing: DE preferred, not 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. 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 (75,000 - 90,000). 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. 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.

United States
$75K - $90K / year
Prudential logo

Senior Disability Claims Examiner, Concierge Team (Virtual)

Prudential

Prudential is one of the world’s largest financial and insurance services companies. The employer offers eligible employees a comprehensive benefits package t

Job Classification: Operations - Insurance Operations The Financial Services Team, within the Group Insurance Disability Organization, is seeking a Partial Calculation Specialist. The successful candidate will be expected to interpret and calculate partial disability payments according to contractual provisions, procedures, and federal and state regulations. The role will require the ability to analyze information specific to earned income, contractual provisions, and benefits paid to ensure the accuracy of partial disability payments on disability claims as outlined within the policy. What you can expect: - Analyze information on file specific to partial disability payments such as paystubs, timesheets, and other contractual provisions. - Perform calculations of partial disability payments specific to Paid Leave, STD, and LTD. - Offer technical support to the Group Insurance Disability Organization related to partial calculations. - Collaborate with the Group Insurance Disability Organization to address challenges related to adjustments. - Respond to customer service issues within required timeframes to meet customer expectations. What you’ll need: - Minimum of 2 years in Group Insurance of similar claims experience required. - Demonstrated understanding of partial disability calculations. - Demonstrated understanding of all contractual provisions such as Greatest Extent and Return to Work Incentives, that would impact partial disability payments. - Effective communication skills. - Ability to solve complex claim scenarios with some guidance. - Ability to adapt to the changing needs of the organization. - Proficiency in Teams, MS Word, and Excel. #LI-MG1 What we offer you: Prudential is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $61,700.00 to $101,900.00. Specific pricing for the role may vary within the above range based on many factors including geographic location, candidate experience, and skills. - Market competitive base salaries, with a yearly bonus potential at every level. - Medical, dental, vision, life insurance, disability insurance, Paid Time Off (PTO), and leave of absences, such as parental and military leave. - 401(k) plan with company match (up to 4%). - Company-funded pension plan. - Wellness Programs including up to $1,600 a year for reimbursement of items purchased to support personal wellbeing needs. - Work/Life Resources to help support topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development. - Education Benefit to help finance traditional college enrollment toward obtaining an approved degree and many accredited certificate programs. - Employee Stock Purchase Plan: Shares can be purchased at 85% of the lower of two prices (Beginning or End of the purchase period), after one year of service. Eligibility to participate in a discretionary annual incentive program is subject to the rules governing the program, whereby an award, if any, depends on various factors including, without limitation, individual and organizational performance. To find out more about our Total Rewards package, visit Work Life Balance | Prudential Careers. Some of the above benefits may not apply to part-time employees scheduled to work less than 20 hours per week. Prudential Financial, Inc. of the United States is not affiliated with Prudential plc. which is headquartered in the United Kingdom. Prudential is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, ancestry, sex, sexual orientation, gender identity, national origin, genetics, disability, marital status, age, veteran status, domestic partner status, medical condition or any other characteristic protected by law. If you need an accommodation to complete the application process, please email accommodations.hw@prudential.com. If you are experiencing a technical issue with your application or an assessment, please email careers.technicalsupport@prudential.com to request assistance.

United States + 3 moreAll locations: United States | India | Indonesia | Tunisia
$61.7K - $101K / year
Job Closed