Remote Workers' Comp Claims Adjuster

Sedgwick; Toledo (OH); Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Flexible schedule

Referral program

Agile environment

Career development

Benefits package

Job summary

Sedgwick is seeking a remote Claims Adjuster - Workers Compensation with jurisdiction coverage MI, TX, IN, IL, OH. The role involves analyzing mid- to high-level workers compensation claims to determine benefits, adjudicate, and pursue subrogation where needed.

The ideal candidate has a Bachelor's degree and at least four years of claims management experience, with licensing in the home state and knowledge of multiple jurisdictions. Flexible schedule and comprehensive benefits are offered.

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 seeking a remote Claims Adjuster - Workers Compensation with jurisdiction coverage MI, TX, IN, IL, OH. The role involves analyzing mid- to high-level workers compensation claims to determine benefits, adjudicate, and pursue subrogation where needed.

The ideal candidate has a Bachelor's degree and at least four years of claims management experience, with licensing in the home state and knowledge of multiple jurisdictions. Flexible schedule and comprehensive benefits are offered.