Remote Claims Examiner, Workers' Compensation

Sedgwick; Concord (NH); Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401k matching

PTO

Disability insurance

Life insurance

Employee assistance

Job summary

Sedgwick is seeking a Claims Examiner for Workers’ Compensation in AK with remote work options. The role involves processing low-level claims, determining benefits, and coordinating action plans under supervision.

Ideal candidates have claims management experience and AK jurisdiction knowledge. The company emphasizes care counts, flexible schedules, and a strong benefits package including medical, dental, vision, and 401k matching.

Qualifications

• Education & Licensing: 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 processing

Attention to detail

Communication skills

Caseload management

Education

High School Diploma or GED

Bachelor’s degree preferred

Job description

Sedgwick is seeking a Claims Examiner for Workers’ Compensation in AK with remote work options. The role involves processing low-level claims, determining benefits, and coordinating action plans under supervision.

Ideal candidates have claims management experience and AK jurisdiction knowledge. The company emphasizes care counts, flexible schedules, and a strong benefits package including medical, dental, vision, and 401k matching.