Job Details

Join Sedgwick and contribute to a meaningful mission as part of a dedicated team that supports individuals facing unexpected challenges. We offer a nurturing culture, opportunities for career growth, and a strong commitment to work-life balance. Explore your potential with us, where your achievements know no bounds.

Recognized by Newsweek as one of America's Greatest Workplaces and certified as a Great Place to Work®, Sedgwick is also listed among Fortune's Best Workplaces in Financial Services & Insurance.

PRIMARY PURPOSE: To evaluate complex workers' compensation claims to determine entitled benefits, manage high-stakes claims involving litigation and rehabilitation, and maintain compliance with service expectations, industry standards, and client requirements while handling subrogation and negotiating settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Thoroughly analyze and manage complex workers' compensation claims through investigative methods and information gathering to assess claim exposure, developing effective action plans to resolve claims timely.

• Effectively negotiate claim settlements within established authority limits.

• Accurately calculate and assign timely reserves for claims, ensuring reserve adequacy throughout the claims lifecycle.

• Calculate and pay due benefits promptly; ensure timely claim payments and necessary adjustments; and settle claims as per authority guidelines.

• Prepare required state filings within legal parameters.

• Oversee the litigation process to ensure efficient and cost-effective claim resolutions.

• Coordinate with vendors for further investigation and litigation management as needed.

• Implement cost containment strategies and form strategic vendor partnerships to minimize overall claims costs.

• Manage various claim recoveries, including subrogation and offsets related to Social Security and Medicare.

• Report claims to excess carriers and respond promptly to their inquiries with professionalism.

• Maintain clear communication regarding claims progress with claimants and clients, fostering professional relationships.

• Ensure accurate documentation of claims files and correct coding.

• Refer cases to supervisors and management when necessary.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Perform additional duties as assigned.

• Participate in the organization's quality programs.

• Travel as required.

QUALIFICATIONS

Education & Licensing

A Bachelor's degree from an accredited college or university is preferred. Relevant professional certification in the field is also preferred.

Licensing / Jurisdiction Knowledge: IN, IL, IA, MI, WI

Experience

Minimum of five years of claims management experience or an equivalent combination of education and experience is required.

Skills & Knowledge

• Expert knowledge of insurance principles relevant to the line of business, recoveries, offsets, durations, and cost containment strategies.

• Exceptional oral and written communication skills, including the ability to present information effectively.

• Proficient in PC applications, specifically Microsoft Office.

• Strong analytical and interpretive abilities.

• Excellent organizational and interpersonal skills.

• Outstanding negotiation skills.

• Able to work collaboratively in a team environment.

• Consistently meet or exceed service expectations.

WORK ENVIRONMENT

We provide accommodations as needed and appropriate.

Mental: Requires clear, conceptual thinking; strong judgment; problem-solving skills; the ability to manage stress; and the capacity to handle multiple priorities and deadlines.

Physical: Involves computer keyboarding and occasional travel.

Auditory/Visual: Requires good hearing, vision, and verbal communication abilities.

As per legal requirements, Sedgwick provides range compensation for roles in regions necessitating pay transparency. Actual compensation may vary based on experience, skills, and location. For this specific job posting, starting pay ranges from $75,000 to $95,000 per year. We offer an extensive benefits package, including medical, dental, vision, 401k matching, PTO, disability, life insurance, employee assistance programs, and flexible spending accounts.

The job description is intended to illustrate the general nature of work and is not a comprehensive list of functions or duties. Management retains the right to modify roles as necessary.

Sedgwick is an Equal Opportunity Employer and maintains a Drug-Free Workplace.

If you're interested in this role but feel your experience doesn't align perfectly with every requirement, we encourage you to apply anyway! Sedgwick values diversity and recognizes the unique skills each individual brings to our organization.

Sedgwick is the leading risk management and claims administration partner, helping clients thrive in the face of the unexpected. With cutting-edge, AI-enabled technology and a dedicated workforce of over 33,000 colleagues, we provide effective solutions in claims administration, benefits management, and risk management across 80 countries worldwide.