Remote Claims Adjuster, Workers' Compensation Expert

Sedgwick; Dover (DE); Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Agile environment

Career development opportunities

Benefits: medical, dental, vision, 401

Job summary

Sedgwick is seeking a remote Workers' Compensation Claims Adjuster to analyze mid- and high-level claims and determine benefits due. The role emphasizes adjudication under company standards with a focus on accurate reserve management and potential subrogation.

Requires a bachelor's degree, four years of claims management experience, and home-state licensing. Offers a flexible schedule, comprehensive benefits, and remote work opportunities across the United States.

Qualifications

• Bachelor's degree preferred; professional certification as applicable to line of business preferred.
• Four years of claims management experience or equivalent combination of education and experience required.
• Jurisdiction knowledge: MI, TX, IN, IL, OH; Home State licensing required.

Responsibilities

• Manages workers compensation claims determining compensability and benefits due on long term indemnity claims; monitors reserve accuracy and files state agency documentation.
• Develops and manages workers compensation claims’ action plans to resolution; coordinates return-to-work efforts and approves payments.
• Approves and processes assigned claims, determines benefits due, and manages action plan per claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim actions with claimants and clients.
• Ensures claim files are properly documented and coding is correct.
• May process complex lifetime medical and/or defined period medical claims including state and physician filings.

Skills

Claims adjudication

Analytical thinking

Remote work

Education

Bachelor's degree

Professional licensing

Job description

Sedgwick is seeking a remote Workers' Compensation Claims Adjuster to analyze mid- and high-level claims and determine benefits due. The role emphasizes adjudication under company standards with a focus on accurate reserve management and potential subrogation.

Requires a bachelor's degree, four years of claims management experience, and home-state licensing. Offers a flexible schedule, comprehensive benefits, and remote work opportunities across the United States.