Remote Workers' Comp Claims Adjuster | Flexible Schedule

Sedgwick; Carson City (NV); Remote; USD 60,000 - 85,000; Full time

Benefits offered by this job

Flexible schedule

Referral program

Agile environment

Career development

Comprehensive benefits

Job summary

Sedgwick is seeking a Claims Adjuster - Workers' Compensation to analyze mid- and higher-level claims, determine benefits, and ensure adjudication aligns with company standards. This remote role covers multiple jurisdictions and emphasizes accurate documentation and client collaboration.

You will manage action plans, coordinate return-to-work, approve payments, and negotiate settlements while maintaining professional client relationships and compliance with regulatory requirements.

Qualifications

• Education and Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
• Four (4) years of claims management experience or equivalent combination of education and experience 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

Adjudication

Subrogation

Negotiation

Communication with clients

Education

Bachelor's degree

Professional certification (as applicable)

Job description

Sedgwick is seeking a Claims Adjuster - Workers' Compensation to analyze mid- and higher-level claims, determine benefits, and ensure adjudication aligns with company standards. This remote role covers multiple jurisdictions and emphasizes accurate documentation and client collaboration.

You will manage action plans, coordinate return-to-work, approve payments, and negotiate settlements while maintaining professional client relationships and compliance with regulatory requirements.