Remote Workers' Comp Claims Adjuster

Sedgwick; Detroit (MI); Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentives

Agile environment

Career growth

Comprehensive benefits

Job summary

Sedgwick is hiring a Claims Adjuster for Workers' Compensation, with remote work options across MI, TX, IN, IL, and OH. You will adjudicate complex claims, determine benefits, manage subrogation, and coordinate with clients and claimants to reach settlements.

The ideal candidate has 4 years of claims management experience, a Bachelor’s degree, and state licensing. Flexible schedules and comprehensive benefits accompany a supportive, diverse work culture.

Qualifications

• Bachelor's degree preferred.
• Four years of claims management experience or equivalent.
• 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.

Skills

Workers' compensation claims

Claims adjudication

Negotiation

Regulatory compliance

Client communication

Education

Bachelor's degree

Job description

Sedgwick is hiring a Claims Adjuster for Workers' Compensation, with remote work options across MI, TX, IN, IL, and OH. You will adjudicate complex claims, determine benefits, manage subrogation, and coordinate with clients and claimants to reach settlements.

The ideal candidate has 4 years of claims management experience, a Bachelor’s degree, and state licensing. Flexible schedules and comprehensive benefits accompany a supportive, diverse work culture.