Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. 

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work®
Top 100 Most Loved Workplace® 
Forbes Best-in-State Employer

Claims Examiner - Workers Compensation

PRIMARY PURPOSE: To manage worker compensation claims on behalf of clients and to act as a client advocate before Provincial Worker Compensation Boards. Analyze complex or technically difficult workers' compensation claims. Ensure ongoing management of claims within service expectations, industry best practices and specific client service requirements; and to identify cost saving opportunities bring claims to resolution.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

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.Review decisions made by Provincial Worker Compensation Boards and determine if decisions are appropriate and within the legislation.Provide claim analysis to client to determine if decisions require formal appeal.Settles clams within designated authority level.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 our clients.Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.Ensures claim files are properly documented and claims coding is correct.Refers cases as appropriate to supervisor and management.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.Supports the organization's quality program(s).Travels as required.

QUALIFICATION

Education & Licensing
Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience
Five (5) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

Excellent oral and written communication, including presentation skillsKnowledge of legislation of Provincial WC BoardsPC literate, including Microsoft Office productsAnalytical and interpretive skillsStrong organizational skillsGood interpersonal skillsExcellent negotiation skillsAbility to work in a team environmentAbility to meet or exceed Service Expectations

We are committed to inclusive, barrier-free recruitment and selection processes. If contacted for an employment opportunity, please advise Colleague Resources if you require accommodation.

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.

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. Sedgwick retains the discretion to add or to change the duties of the position at any time.