Remote Claims Examiner - Workers' Compensation

Sedgwick; Spokane (WA); Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Flexible schedule

Referral program

Career development

Health benefits

401k on day one

Disability insurance

Life insurance

PTO

Job summary

Sedgwick is seeking a Claims Examiner - Workers Compensation to process low level workers compensation claims and determine benefits due, with oversight to ensure adjudication aligns with standards. This role supports subrogation efforts and settlement negotiations under supervision.

The ideal candidate has 5 years of claims management experience with a focus on workers' compensation, and can operate in a remote/telecommuter setting across multiple states, including AK.

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 handling

Attention to detail

Communication skills

Problem solving

Education

High School Diploma or GED

Bachelor's degree preferred

Professional certification

Job description

Sedgwick is seeking a Claims Examiner - Workers Compensation to process low level workers compensation claims and determine benefits due, with oversight to ensure adjudication aligns with standards. This role supports subrogation efforts and settlement negotiations under supervision.

The ideal candidate has 5 years of claims management experience with a focus on workers' compensation, and can operate in a remote/telecommuter setting across multiple states, including AK.