Claims Adjuster - Workers Compensation REMOTE

Lensa; Fayetteville (NC); Remote; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated Claims Adjuster for remote work. This role involves analyzing and managing workers' compensation claims, ensuring compliance with regulations, and negotiating settlements. You'll be part of a supportive environment that values diversity and inclusion, providing you the opportunity to make a meaningful impact in the lives of others. Join a team that prioritizes your well-being and professional growth, where your contributions are recognized and celebrated. If you are passionate about helping others and thrive in a collaborative setting, this is the perfect opportunity for you.

Qualifications

• Four years of claims management experience or equivalent education.
• Bachelor's degree preferred from an accredited institution.

Responsibilities

• Analyze and manage workers compensation claims to determine benefits.
• Negotiate settlements and maintain professional client relationships.

Skills

Claims Management

Analytical Skills

Negotiation Skills

Communication Skills

Organizational Skills

Interpersonal Skills

PC Literacy

Education

Bachelor's Degree

Tools

Microsoft Office

Job description

3 days ago Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, Sedgwick, is seeking professionals. Apply via Lensa today!

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 Adjuster - Workers Compensation REMOTE

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:

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

Physical and mental requirements as described.

Note: The statements are general and not exhaustive. Management may change duties as needed.

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

If your experience doesn't align perfectly, consider applying anyway! We value diversity, equity, and inclusion, and believe each person has unique skills and experiences. You might be the right fit for this or other roles.

Taking care of people is at the heart of everything we do. Caring counts.