Remote Workers' Comp Claims Adjuster

Sedgwick; Dover (DE); Remote; USD 60,000 - 85,000; Full time

Benefits offered by this job

Flexible schedule

Referral program

Agile environment

Career growth

Benefits package

Job summary

Sedgwick is seeking a Claims Adjuster - Workers’ Compensation to analyze mid- and higher-level workers compensation claims, determine benefits due, and ensure adjudication aligns with standards and industry best practices.

Role includes managing subrogation, negotiating settlements, and maintaining thorough claim documentation while coordinating with claimants and clients across jurisdiction TX, MN, MI. Remote work available in designated states.

Qualifications

• Bachelor's degree from an accredited college or university preferred.

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

Claims management experience

Education

Bachelor's degree

Job description

Sedgwick is seeking a Claims Adjuster - Workers’ Compensation to analyze mid- and higher-level workers compensation claims, determine benefits due, and ensure adjudication aligns with standards and industry best practices.

Role includes managing subrogation, negotiating settlements, and maintaining thorough claim documentation while coordinating with claimants and clients across jurisdiction TX, MN, MI. Remote work available in designated states.