Remote Claims Examiner, Workers' Compensation

Sedgwick; Boise (ID); Remote; USD 75,000 - 90,000; Full time

Job summary

Sedgwick in AK is seeking a Claims Examiner for Workers' Compensation with jurisdiction and licensing in AK. The role handles low-level claims with guidance, ensuring benefits are determined and adjudicated per policy. Remote work options available where permitted.

Ideal candidates have strong claims processing skills, attention to detail, and the ability to communicate effectively with claimants and clients while maintaining professional relationships.

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 experience

Education

High School Diploma or GED

Bachelor's degree

Professional certification

Job description

Sedgwick in AK is seeking a Claims Examiner for Workers' Compensation with jurisdiction and licensing in AK. The role handles low-level claims with guidance, ensuring benefits are determined and adjudicated per policy. Remote work options available where permitted.

Ideal candidates have strong claims processing skills, attention to detail, and the ability to communicate effectively with claimants and clients while maintaining professional relationships.