Claims Examiner - Workers Comp (REMOTE/ AL,GA,MS, NC,SC,TN,VA, KY Exp needed)

As a Claims Examiner - Workers Comp at Sedgwick, your main responsibilities include analyzing complex workers' compensation claims, negotiating settlements, ensuring timely claim payments, and managing litigation processes. Your role involves gathering information to determine claim exposure, calculating reserves, and maintaining professional relationships with both clients and claimants. Through your work, you play a vital role in assuring that individuals receive their rightful claims while adhering to industry best practices and our clients' service expectations.

To qualify for the Claims Examiner - Workers Comp position at Sedgwick, candidates typically need a bachelor's degree from an accredited institution, although significant experience in claims management can substitute for educational requirements. Five years of relevant experience or an equivalent combination of education and experience are also essential. Additionally, familiarity with insurance principles, excellent negotiation skills, and strong organizational capabilities are highly desirable.

Sedgwick is dedicated to fostering an environment that promotes professional growth for its Claims Examiners. Employees are encouraged to sharpen their skills through comprehensive training and access to resources that aid in career advancement. Additionally, the inclusive culture at Sedgwick means that individuals from diverse backgrounds can thrive and bring unique perspectives to the team, which enhances both personal development and overall company success.

As a Claims Examiner - Workers Comp at Sedgwick, you will be utilizing a range of tools and technologies, primarily including Microsoft Office products and specialized claims management systems. These tools are designed to support your claims analysis, document management, and communication efforts, ensuring that your work is efficient and effective. Sedgwick is committed to providing the required technology to help you succeed in your role.

The work culture at Sedgwick is characterized by respect, inclusion, and support. As a Claims Examiner - Workers Comp, you will be part of a team that prioritizes employee well-being, encourages collaboration, and values diversity. Sedgwick takes pride in being recognized as a Great Place to Work, where colleagues support one another and contribute to a meaningful mission. This positive atmosphere fosters both personal and professional satisfaction.

When answering this question, break down your relevant experience by describing specific roles and responsibilities you’ve held that relate to workers' compensation claims. Highlight your analytical skills, ability to negotiate settlements, and any success stories of claims you've managed effectively. Tailor your response to demonstrate how this experience aligns with the responsibilities outlined in the Claims Examiner role at Sedgwick.

To effectively answer this question, discuss your methods for organization and prioritization. Detail how you manage timelines, ensure all documentation is accurate, and stay up-to-date on statutory requirements. It’s important to illustrate your understanding of the claims process and your commitment to service expectations so that potential employers can see how you strive for accuracy in your work.

In your response, choose a specific example that outlines the challenge, the steps you took to address it, and the outcome. Focus on your problem-solving abilities and how you collaborated with others, emphasizing skills such as negotiation and analysis that would be relevant to a Claims Examiner - Workers Comp at Sedgwick.

Demonstrate your communication strategies by discussing the techniques you use to keep clients informed and engaged throughout the claims process. Emphasize listening skills, your clarity in explaining complex concepts, and how you tailor communications based on the client's level of understanding, showcasing your client management skills relevant to Sedgwick.

Your answer should highlight specific methods you utilize to keep informed, such as attending relevant courses, reading industry publications, and networking with professionals in the field. This demonstrates your commitment to maintaining relevant knowledge for the role of a Claims Examiner - Workers Comp and underlines your dedication to compliance and accuracy, which is crucial at Sedgwick.

When addressing your negotiation style, discuss your approach to understanding the positions of both clients and insurers. Emphasize active listening skills and how you find common ground to facilitate a fair settlement. This response should convey your ability to handle sensitive discussions professionally, an essential quality for a Claims Examiner at Sedgwick.

To successfully respond to this question, outline your time management and organizational techniques. Discuss how you prioritize tasks based on urgency and impact and how you utilize tools or methodologies, such as task lists or project management software, to remain effective under pressure. This will show your potential fit for the dynamic environment at Sedgwick.

Here, express your understanding of subrogation, defining it clearly and explaining its importance in the claims process. Provide examples of how you’ve handled subrogation cases in the past and the results. Discussing your practical knowledge about recovery efforts demonstrates your depth of expertise in workers' compensation claims that would align with your role at Sedgwick.

Communicate your commitment to quality assurance by detailing methods you use to double-check your work, seek peer reviews, and ensure compliance with company policies. Employers at Sedgwick will be looking for your dedication to maintaining high standards and delivering quality results in the role of a Claims Examiner.

In answering this question, identify current challenges like evolving regulations, the rise of technology in claims processing, and the need for enhanced communication with claimants. Provide your insights into how these challenges can be addressed through proactive measures that support both the clients and the claims process at Sedgwick. This demonstrates your awareness of industry trends and your strategic thinking abilities.