Claims Adjuster – Workers Compensation (Remote – Southeast State exp needed)

Sedgwick; Missouri; Remote; USD 55,000 - 75,000; Full time

Job summary

A leading risk and claims administration firm is seeking a Claims Adjuster to analyze and manage workers compensation claims. The ideal candidate will have a Bachelor's degree and four years of relevant experience. Responsibilities include determining benefits, managing claims, and communicating with clients. The position offers a flexible work schedule and comprehensive benefits.

Benefits

Flexible work schedule

Referral incentive program

Career development opportunities

Comprehensive benefits offering including medical, dental, vision

Qualifications

• Four years of Workers Compensation claims management experience or equivalent is required.
• Ability to manage subrogation of claims and negotiate settlements.
• Experience with documentation and claim coding.

Responsibilities

• Analyze and manage workers compensation claims.
• Communicate claim actions with claimants and clients.
• Ensure claims are compliant with company standards.

Skills

Workers Compensation claims management

Client communication

Negotiation skills

Analytical skills

Education

Bachelor’s degree from an accredited college or university

Job description

Overview

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 (Remote – Southeast State exp needed)

Ideal Candidate

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

: 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 Workers Compensation claims management experience or equivalent combination of education and experience required.

Taking Care Of You

• Flexible work schedule.

• Referral incentive program.

• Career development and promotional growth opportunities.

• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

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.

Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com