Remote Workers' Comp Claims Adjuster

Sedgwick; Denver (CO); Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Agile environment

Career development & growth

Comprehensive benefits package

Job summary

Sedgwick is recruiting for a Telecommuter Claims Adjuster - Workers Compensation, handling mid- and higher-level claims across multiple jurisdictions. The role focuses on adjudicating benefits and managing subrogation, with licensing required and a remote work setup.

The ideal candidate will have a Bachelor's degree and at least four years in claims management, with knowledge of MI, TX, IN, IL, and OH. A home state license is required, and a flexible, growth-oriented environment is emphasized.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Four (4) years of claims management experience or equivalent combination of education and experience required.
• Jurisdiction Knowledge: MI, TX, IN, IL, OH
• Licensing: Home State Required

Responsibilities

• Manages 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 manages workers compensation claims’ action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages 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 complex 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.

Education

Bachelor's degree

Job description

Sedgwick is recruiting for a Telecommuter Claims Adjuster - Workers Compensation, handling mid- and higher-level claims across multiple jurisdictions. The role focuses on adjudicating benefits and managing subrogation, with licensing required and a remote work setup.

The ideal candidate will have a Bachelor's degree and at least four years in claims management, with knowledge of MI, TX, IN, IL, and OH. A home state license is required, and a flexible, growth-oriented environment is emphasized.