Claims Examiner - Workers Compensation | Jurisdiction: NY | Licensing: NY - Remote

WORK LOCATIONS : Hybrid if located within a 25 mile radius of any Sedgwick Offices, if located outside of the radius the position will work remote.

PRIMARY PURPOSE OF THE ROLEToanalyze Workers Compensationclaims 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.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• Manages complex workers’ compensation claims from initial investigation through final resolution
• Evaluates claim exposure and develops action plans to drive timely, effective outcomes
• Negotiates settlements within authority while ensuring compliance with guidelines
• Establishs and maintains accurate reserves throughout the life of each claim
• Calculates and issues benefit payments, adjustments, and settlements in a timely manner
• Prepares and submits required state filings within statutory deadlines
• Oversees litigation, partnering with vendors to manage strategy and control costs
• Applies cost containment strategies, including use of preferred vendor partnerships
• Handles claim recoveries such as subrogation, Second Injury Fund, and Medicare/SS offsets
• Reports to excess carriers and responds to requests promptly and professionally
• Communicates regularly with claimants and clients to provide updates and maintain strong relationships
• Ensures claim files are well-documented and coded accurately
• Escalates complex or high-risk cases to leadership as appropriate

QUALIFICATIONS

Education & Licensing: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.

Experience: 5 years of claims management experience or equivalent combination of education and experience required.

Licensing / Jurisdiction Knowledge: NY jurisdiction and NY licensing

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.

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WORK ENVIRONMENT REQUIREMENTSINCLUDE
When applicable and appropriate, consideration will be given to reasonable accommodations.