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

Sedgwick; South Dakota; Remote; USD 55,000 - 75,000; Full time

Job summary

A leading claims management firm is seeking a remote Claims Adjuster in South Dakota. The role involves analyzing workers compensation claims, managing action plans, and negotiating settlements. Ideal candidates should have four years of experience in claims management and a Bachelor's degree. The company offers a flexible schedule and a comprehensive benefits package.

Benefits

Flexible work schedule

Referral incentive program

Career development opportunities

Comprehensive benefits including medical and 401K

Qualifications

• Four years of Workers Compensation claims management experience or equivalent.
• Ability to analyze mid- and higher-level claims.
• Experience with claim action plans and settlement negotiations.

Responsibilities

• Analyze workers compensation claims to determine benefits due.
• Manage claims action plans to resolution.
• Negotiate settlements for subrogation of claims.

Skills

Claims management

Negotiation

Communication

Analytical skills

Client relations

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)

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?

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.