Remote Claims Examiner - Workers' Comp

Sedgwick; Trenton (NJ); Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Agile environment

Career development

Job summary

Sedgwick is hiring for a Claims Examiner - Workers Compensation role with AK jurisdiction, offering remote work options across applicable states. The position involves processing low level workers compensation claims, managing subrogation, and coordinating action plans from intake to settlement.

Strong accuracy and client communication are essential. Qualified candidates typically have several years in claims management, a high school diploma or GED, and may hold a Bachelor’s degree or

Qualifications

• 5 years of claims management experience or equivalent combination of education and experience required.
• High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.

Responsibilities

• Processes low level 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 coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
• Administers 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 low-level 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.

Skills

Claims management

Education

High School Diploma or GED

Bachelor's degree preferred

Professional certification

Job description

Sedgwick is hiring for a Claims Examiner - Workers Compensation role with AK jurisdiction, offering remote work options across applicable states. The position involves processing low level workers compensation claims, managing subrogation, and coordinating action plans from intake to settlement.

Strong accuracy and client communication are essential. Qualified candidates typically have several years in claims management, a high school diploma or GED, and may hold a Bachelor’s degree or