Remote Claims Examiner - Workers' Compensation

Sedgwick; Columbia (SC); Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development and promotional成长

Job summary

Sedgwick in the United States is seeking a Claims Examiner for Workers' Compensation with remote options for AK jurisdictions. You will process low level claims, determine benefits, and coordinate subrogation under supervision.

Ideal candidates have strong analytical skills, a commitment to accuracy, and the ability to maintain professional client relationships. Sedgwick offers a comprehensive benefits package and a flexible, supportive work environment.

Qualifications

• 5 years of claims management experience or equivalent combination of education and experience required.
• High School Diploma or GED required; Bachelor's degree 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 preferred

Professional certification preferred

Job description

Sedgwick in the United States is seeking a Claims Examiner for Workers' Compensation with remote options for AK jurisdictions. You will process low level claims, determine benefits, and coordinate subrogation under supervision.

Ideal candidates have strong analytical skills, a commitment to accuracy, and the ability to maintain professional client relationships. Sedgwick offers a comprehensive benefits package and a flexible, supportive work environment.