Claims Adjuster - Workers Compensation | Jurisdiction: TX, MN, MI | Licensing: TX or Home State required - Remote

Sedgwick; Alabama; On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentive

Career development

Health benefits

401K match

Job summary

Sedgwick is hiring a Claims Adjuster for Workers’ Compensation with licensing in TX or home state. The role analyzes mid-to-high level worker’s compensation claims, approves benefits, and coordinates settlements while maintaining client relationships.

Ideal candidates will have four years of claims experience, a bachelor’s degree, and relevant certifications. Remote work is available in jurisdictions like TX, MN, and MI with a comprehensive benefits package.

Qualifications

• Bachelor's degree preferred; professional certification relevant to line of business recommended.
• Four years of claims management experience required.
• Licensing: TX or Home State preferred for remote roles.

Responsibilities

• Manages workers' compensation claims determining compensability and benefits due, monitors reserves, files documentation with state agencies.
• Develops and manages action plans for claims resolution, coordinates return‑to‑work, approves payments.
• Determines benefits due, manages subrogation, negotiates settlements, communicates with claimants and clients.

Skills

Claims management

Education

Bachelor's degree

Professional certification

Job description

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Claims Adjuster - Workers Compensation | Jurisdiction: TX, MN, MI | Licensing: TX or Home State required - Remote

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?

Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

ARE YOU AN IDEAL CANDIDATE?

We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

PRIMARY PURPOSE OF THE ROLE:

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 Responsiblities May Include

• 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.

Qualifications

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

Experience

Four (4) years of claims management experience or equivalent combination of education and experience required.

Jurisdiction Knowledge: TX, MN, MI

Licensing: TX

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

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

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

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

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.

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 ($60,000.00-$85,000.00. 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.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.