Claims Examiner

7 days ago


Cape Town, South Africa Sedgwick Full time

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®

Most Loved Workplace®

Forbes Best-in-State Employer

Claims Examiner - Workers Compensation (CT/MA/NH/RI/VT)
- Claims examiner
- Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?
- Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.
- Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
- Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.
- Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
- Enjoy flexibility and autonomy in your daily work, your location, and your career path.
- Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
- PRIMARY PURPOSE OF THE ROLE: We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
- ARE YOU AN IDEAL CANDIDATE? To analyze workers compensation claims 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
- Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
- Negotiating settlement of claims within designated authority.
- Communicating claim activity and processing with the claimant and the client.
- Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
- QUALIFICATIONS
- Education & Licensing: 3 years of claims management experience or equivalent combination of education and experience required.
- 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.
- Licensing / Jurisdiction Knowledge: NY, MA,CT,RI,NH
- 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.
- Work environment requirements for entry-level opportunities include
- Physical: Computer keyboarding
Auditory/visual: Hearing, vision and talking
Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.
- #claimsexaminer
- As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in _this job posting only, the range of starting pay for this role is 60K-84. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.



  • Cape Town, South Africa Rand Mutual - Rma Full time

    A leading insurance company in Cape Town is seeking a Claims Assessor to manage and adjudicate claims efficiently. The ideal candidate will have a FAIS Regulatory Examination (RE5) and an NQF Level 5 qualification, along with 3 to 5 years of claims experience. Key duties include processing claims accurately, managing customer inquiries, and collaborating...


  • Cape Town, South Africa The Recruitment Council Full time

    An established financial services business is seeking a detail-oriented and experienced Underwriter and Claims Administrator to provide underwriting and claims assistance to Advisers, with a focus on both Commercial and Personal Lines.This role requires strong administrative skills, in-depth product knowledge and excellent communication with clients and...

  • Claims Advisor

    1 week ago


    Cape Town, South Africa Marsh Full time

    **Claims Advisor - Marsh - Brackenfell, Cape Town - Fixed Term Contract** **Please note this role will be based onsite at our clients’ offices - Shoprite Monday to Friday.** **The company: Marsh** Marsh is the world’s leading insurance broker and risk adviser. With over 35,000 colleagues operating in more than 130 countries, Marsh serves commercial...

  • Claims Assessor

    3 weeks ago


    Cape Town, South Africa Rand Mutual - Rma Full time

    Job Description THE JOB AT A GLANCE As a Claims Assessor, you will be reporting to the Team Leader: Claims Assessor. What will you do? You will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out by Rand Mutual Assurance. Claims Adjudication : Verify claims captured for...

  • Claims Assessor

    1 week ago


    Cape Town, Western Cape, South Africa Rand Mutual - RMA Full time R250 000 - R500 000 per year

    Job DescriptionTHE JOB AT A GLANCEAs a Claims Assessor, you will be reporting to the Team Leader: Claims Assessor. You will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out by Rand Mutual Assurance.WHAT WILL YOU DO?Claims Adjudication:Verify claims captured for correctness and...

  • Claims Assessor

    1 week ago


    Cape Town, Western Cape, South Africa Rand Mutual Assurance Full time R250 000 - R500 000 per year

    THE JOB AT A GLANCEAs a Claims Assessor, you will be reporting to the Team Leader: Claims Assessor. You will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out by Rand Mutual Assurance.WHAT WILL YOU DO?Claims Adjudication:Verify claims captured for correctness and...


  • Cape Town, South Africa Sanlam Full time

    **Who are we?** Santam is the market leader in the general insurance industry in Southern Africa. We are a large, diversified, expanding and transforming company and whilst based in South Africa, we are rapidly moving into a number of emerging markets, both in Africa and Asia. Our success is rooted in our passion for our clients and everything we do is...

  • Claims Assessor

    2 days ago


    Cape Town, South Africa Rand Mutual Assurance Full time

    **THE JOB AT A GLANCE** As a Claims Assessor, you will be reporting to the Team Leader: Claims Assessor. You will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out by Rand Mutual Assurance. **WHAT WILL YOU DO?** **Claims Adjudication**: - Verify claims captured for...

  • Claims Assessor

    4 weeks ago


    Cape Town, South Africa Rand Mutual - RMA Full time

    Position Overview As a Claims Assessor, you will be reporting to the Team Leader: Claims Assessor. You will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out by Rand Mutual Assurance. What Will You Do? Claims Adjudication Verify claims captured for correctness and compliance...

  • Claims Assessor

    3 weeks ago


    Cape Town, South Africa Rand Mutual - Rma Full time

    Position Overview As a Claims Assessor, you will be reporting to the Team Leader: Claims Assessor. You will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out by Rand Mutual Assurance. What Will You Do? Claims Adjudication Verify claims captured for correctness and compliance....