Remote Claims Examiner: Workers’ Compensation

Sedgwick; Tallahassee (FL); Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development opportunities

Comprehensive benefits

Job summary

Sedgwick is seeking a Claims Examiner - Workers Compensation for AK jurisdiction with remote work options. This role focuses on processing low level workers' compensation claims, determining benefits, and advancing adjudication in line with company standards.

Ideal candidates will have at least 5 years of claims management experience, a high school diploma or GED, and may hold professional certifications. Sedgwick offers a comprehensive benefits package and a supportive, inclusive culture.

Qualifications

• 5 years of claims management experience or equivalent.
• 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

Education

High School Diploma or GED

Bachelor’s degree preferred

Professional certification

Job description

Sedgwick is seeking a Claims Examiner - Workers Compensation for AK jurisdiction with remote work options. This role focuses on processing low level workers' compensation claims, determining benefits, and advancing adjudication in line with company standards.

Ideal candidates will have at least 5 years of claims management experience, a high school diploma or GED, and may hold professional certifications. Sedgwick offers a comprehensive benefits package and a supportive, inclusive culture.