Remote Workers' Comp Claims Adjuster – Impact & Growth

Sedgwick Claims Management Services Ltd; Alabama; Hybrid; USD 60,000 - 85,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development opportunities

Comprehensive benefits package

Job summary

Sedgwick, a leading claims management company, is seeking a role focused on analyzing mid- to high-level workers' compensation claims to determine benefits and ensure adjudication aligns with standards and best practices. The role emphasizes subrogation identification and settlement negotiations.

The position requires a Bachelor’s degree and relevant claims experience, with TX licensing and knowledge of the TX, MN, MI jurisdictions.

Qualifications

• 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.
• Jurisdiction Knowledge: TX, MN, MI.
• Licensing: TX.

Responsibilities

• Manages workers compensation claims, determines compensability and benefits on long-term indemnity claims.
• Develops and manages 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 plans 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 with state and physician filings and decisions on treatments.
• Maintains professional client relationships.

Education

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

Professional certification as applicable to line of business preferred.

Job description

Sedgwick, a leading claims management company, is seeking a role focused on analyzing mid- to high-level workers' compensation claims to determine benefits and ensure adjudication aligns with standards and best practices. The role emphasizes subrogation identification and settlement negotiations.

The position requires a Bachelor’s degree and relevant claims experience, with TX licensing and knowledge of the TX, MN, MI jurisdictions.