Claims Adjuster - Workers Compensation (Remote)

Lensa; Knoxville (TN); Remote; USD 68,000 - 114,000; Full time

Job summary

Join a leading global provider of risk and benefits solutions as a Claims Adjuster in Knoxville. This role focuses on managing workers compensation claims, ensuring compliance with industry standards and providing exceptional service to clients. You will play a vital part in the claims process, from analyzing claims to negotiating settlements, all while working in a supportive and inclusive environment. If you are passionate about making a difference and enjoy a challenge, this opportunity is perfect for you. Enjoy the flexibility of remote work while contributing to a company that values its employees and promotes a culture of care.

Qualifications

• 4+ years of claims management experience required.
• Bachelor's degree preferred for this role.

Responsibilities

• Manage workers compensation claims and determine benefits due.
• Develop action plans for claims resolution and coordinate return-to-work efforts.

Skills

Claims Management

Communication Skills

Negotiation Skills

Analytical Skills

Organizational Skills

Interpersonal Skills

PC Literacy (Microsoft Office)

Education

Bachelor's Degree

Job description

2 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.

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.

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.

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

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Finance and Sales

• Industries

  IT Services and IT Consulting

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