Remote Workers' Comp Claims Examiner

Sedgwick; Boise (ID); Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Flexible schedule

Referral program

Career development

Comprehensive benefits

Job summary

Sedgwick seeks a Claims Examiner for Workers’ Compensation to process low to mid-level claims, determine benefits, and coordinate action plans under supervision. This is a remote role with AK jurisdiction, offering a stable environment and growth opportunities.

Applicants should have 5 years of claims management experience, a High School Diploma or GED, AK licensing knowledge, and a willingness to work in agile, client-focused teams.

Qualifications

• 5 years of claims management experience or equivalent combination of education and experience required.
• High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.

Responsibilities

• Processes low level 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 coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
• Administers 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 low-level 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 management

Education

High School Diploma or GED

Bachelor's degree preferred

Professional certification

Job description

Sedgwick seeks a Claims Examiner for Workers’ Compensation to process low to mid-level claims, determine benefits, and coordinate action plans under supervision. This is a remote role with AK jurisdiction, offering a stable environment and growth opportunities.

Applicants should have 5 years of claims management experience, a High School Diploma or GED, AK licensing knowledge, and a willingness to work in agile, client-focused teams.