Remote Workers' Comp Claims Adjuster

Sedgwick; Houston (TX); Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development opportunities

Comprehensive benefits including 401k

Job summary

Sedgwick, a global leader in risk and claims administration, is seeking a remote Workers’ Compensation Claims Adjuster. You will analyze mid- to high-level claims, adjudicate benefits, and coordinate settlements with clients and claimants.

Licensing and home-state requirements apply, with a pathway to stay compliant across multiple jurisdictions. Join Sedgwick to apply your expertise in a flexible, values-driven culture that supports growth, collaboration, and work‑life balance across the United

Qualifications

• Bachelor’s degree preferred with licensing as applicable to line of business.
• Four (4) years of claims management experience or equivalent.
• Jurisdiction knowledge: MI, TX, IN, IL, OH.
• Home state licensing 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

Claims adjudication

Analytical thinking

Communication skills

Education

Bachelor's degree

Job description

Sedgwick, a global leader in risk and claims administration, is seeking a remote Workers’ Compensation Claims Adjuster. You will analyze mid- to high-level claims, adjudicate benefits, and coordinate settlements with clients and claimants.

Licensing and home-state requirements apply, with a pathway to stay compliant across multiple jurisdictions. Join Sedgwick to apply your expertise in a flexible, values-driven culture that supports growth, collaboration, and work‑life balance across the United