About the role

Workers compensation consultant managing Canadian claims, benefits, return-to-work plans, and settlements. Supporting Sedgwick’s claims administration and client service operations.

Responsibilities

Analyze mid- and high-level workers’ compensation claims to determine benefits payable
Ensure the ongoing adjudication of claims in accordance with company standards and industry best practices
Identify subrogation claims and negotiate settlements
Determine compensability and benefits payable for long-term indemnity claims
Monitor reserve accuracy and file required documentation with the applicable provincial or state agency
Develop and manage workers’ compensation claims action plans through resolution
Coordinate return-to-work efforts and approve claim payments
Approve and process assigned claims in accordance with the applicable claim or client contract
Communicate claim actions to claimants and clients
Ensure claim files are properly documented and claim coding is accurate
Process complex lifetime or defined-period medical claims, where applicable, including provincial/state and physician filings and treatment decisions
Maintain professional client relationships
Support the organization’s quality programs
Perform other assigned duties

Bachelor’s degree from an accredited college or university preferred
Four (4) years of claims management experience, or an equivalent combination of education and experience, required
Working knowledge of regulations, offsets and deductions, disability duration, medical management practices, and Social Security and Medicare application procedures applicable to the line of business
Excellent oral and written communication skills, including presentation skills
Proficiency with computers, including Microsoft Office products
Strong analytical and interpretive skills
Strong organizational skills
Good interpersonal skills
Excellent negotiation skills
Ability to work effectively in a team environment
Ability to meet or exceed service expectations
Ability to travel as required