Claims Adjuster I Workers Compensation I CA experience required I Hybrid at Sedgwick Montgomery, AL

Sedgwick; Montgomery (AL); Hybride; USD 47 011 - 70 000; Plein temps

Avantages offerts par ce poste

Medical insurance

Dental insurance

Vision insurance

401(k) with matching

Paid time off

Disability insurance

Life insurance

Employee assistance program

HSA/Flex spending

Résumé du poste

Sedgwick is looking for a Claims Adjuster I – Workers Compensation (CA) in a hybrid work setting. You will analyze mid- to high-level workers' compensation claims to determine benefits, manage reserves, and coordinate subrogation and settlements with clients.

The role requires strong communication and analytical skills, MS Office proficiency, and adherence to regulations and company standards. A bachelor’s degree is preferred, along with four years of claims experience and the ability to support

Qualifications

• Bachelor's degree preferred.
• Four years of claims management experience or equivalent.
• Working knowledge of regulations, offsets and deductions, disability duration, medical management practices, and Social Security/Medicare procedures.

Responsabilités

• Analyzes mid- and higher-level workers' compensation claims to determine benefits due and ensure adjudication within standards.
• Develops and manages action plans, coordinates return-to-work, and approves claim payments.
• Manages subrogation and negotiates settlements with claimants and clients.
• Communicates claim action with claimants and clients and maintains proper documentation.

Connaissances

Regulations knowledge

Disability duration

Medical management

Social Security/Medicare process

Communication skills

MS Office

Analytical skills

Teamwork

Negotiation skills

Formation

Bachelor's degree

Outils

Microsoft Office

Description du poste

Claims Adjuster I – Workers Compensation (CA), Hybrid

Primary Purpose: To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

Essential Functions and Responsibilities

• Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
• Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

Additional Functions and Responsibilities

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

Qualifications

• Education & Licensing: Bachelor's degree from an accredited college or university preferred.
• Experience: Four (4) years of claims management experience or equivalent combination of education and experience required.
• Skills & Knowledge: Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business.
• Excellent oral and written communication, including presentation skills.
• PC literate, including Microsoft Office products.
• Analytical and interpretive skills.
• Strong organizational skill.
• Good interpersonal skills.
• Excellent negotiation skills.
• Ability to work in a team environment.
• Ability to meet or exceed Service Expectations.

Work Environment

Consideration will be given to reasonable accommodations when applicable and appropriate.

Physical, Mental, Auditory/Visual Requirements

Physical: Computer keyboarding, travel as required. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines. Auditory/Visual: Hearing, vision, and talking.

Compensation and Benefits

Pay range: $47,011 - $70,000. Benefits include medical, dental, vision, 401(k) with matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Equal Opportunity Employer

Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace. Sedgwick is committed to a diverse, equitable, and inclusive workplace.