Remote Workers' Comp Claims Adjuster

Sedgwick; Madison (WI); A distancia; USD 60.000 - 75.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, vision

401(k) matching

PTO

Disability and life insurance

Employee assistance

Flexible spending or health savings

Descripción de la vacante

Sedgwick is hiring for a Remote Claims Adjuster - Workers Compensation with jurisdiction coverage MI, TX, IN, IL, OH. The role analyzes mid- to high-level workers' compensation claims to determine benefits and adjudicate per standards.

The position emphasizes subrogation, settlements, and client communications in a flexible work environment; licensing and home-state requirements apply; travel may be required in some cases.

Formación

• 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

Responsabilidades

• 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.

Conocimientos

Claims adjudication

Negotiation

Remote work awareness

Communications

Educación

Bachelor's degree

Licensing: Home State Required

Descripción del empleo

Sedgwick is hiring for a Remote Claims Adjuster - Workers Compensation with jurisdiction coverage MI, TX, IN, IL, OH. The role analyzes mid- to high-level workers' compensation claims to determine benefits and adjudicate per standards.

The position emphasizes subrogation, settlements, and client communications in a flexible work environment; licensing and home-state requirements apply; travel may be required in some cases.