Litigation Consultant Workers Compensation (Sr Claims Examiner)
Litigation Consultant WC (Sr Claims Examiner)
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
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 address cases involving a legal inquiry or dispute and to develop a strategy to bring a case to satisfactory resolution.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Reviews/acts on reports/forms; responds to inquiries; seeks legal opinion and early resolution; and communicates resolution to appropriate parties.
- Responds to decisions, agreement, and/or court order; creates action plan; determines need for examination; gains client authorization.
- Identifies cases for settlements/redemptions.
- Gathers/documents additional information and coordinates with client designees.
- Requests legal/private investigation; assigns to and coordinates with local counsel; monitors local counsel performance.
- Responds to plaintiff's counsel, union, employee, or client requests.
- Identifies issues; formulates defense strategy.
- Establishes/adjusts accrued liability.
- Approves administrative expenses.
- Identifies subrogation opportunities and manages process.
- Attends mediations or hearings as needed.
- Works with partners to affect early return-to-work.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university preferred. Legal courses preferred.
Experience
Six (6) years of claims management experience or equivalent combination of education and experience required. Legal experience preferred.
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
- Excellent interpersonal skills
- Excellent negotiation 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, troubleshooting, problem solving, analysis, 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 is an Equal Opportunity Employer
and a
Drug-Free Workplace
Must currently meet the requirements for designation under AB1262, or have California Self-Insurers Certificate (SIP) or AB1262 California Experienced Examiner Designation. WCCA, WCCP preferred.
Claims Examiner Workers Compensation; Senior Claims Examiner; Claims Adjuster; Claims Representative; Claims Adjuster, Claims Examiner, Claims Representative, Claims Investigator, Claims Analyst, Claims Assistant, Insurance Claims, Claims, Insurance, Future medical, Future Med, Indemnity, loss of time, return to work
Estimated Salary: $20 to $28 per hour based on qualifications.
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