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

Sedgwick Claims Management Services Ltd; Northern (KY); Hybrid; USD 60,000 - 85,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentive program

Career development

Job summary

Sedgwick Claims Management Services is seeking a claims professional to adjudicate mid- to high-level workers compensation claims, determine benefits, and manage subrogation and settlements. The role emphasizes accurate documentation, return-to-work coordination, and client communication.

The ideal candidate has a 4-year claims management background, a bachelor’s degree, and TX licensing with knowledge of TX, MN, and MI jurisdictions. Flexible schedule and benefits are available.

Qualifications

• Bachelor's degree preferred.
• Four (4) years of claims management experience.
• Jurisdiction Knowledge: TX, MN, MI.
• Licensing: TX.

Responsibilities

• Analyze mid- and higher-level workers compensation claims to determine benefits due and adjudicate within company standards.
• Develop and manage claims action plans, coordinate return-to-work, and approve payments.
• Process assigned claims, determine benefits, and manage action plans.
• Manage subrogation and negotiate settlements.
• Communicate claim action with claimant and client.
• Ensure proper documentation and accurate claims coding.

Education

Bachelor's degree

Job description

Claims Adjuster - Workers Compensation | Jurisdiction: TX, MN, MI | Licensing: TX or Home State required - RemoteAre 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.ExperienceFour (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 talkingThe 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.