Remote Workers’ Comp Claims Examiner

Sedgwick; Honolulu (HI); Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentives

Agile environment

Career development

Comprehensive benefits

Job summary

Sedgwick in the United States seeks a full-time Claims Examiner for Workers' Compensation (AK jurisdiction) with remote work options. This role processes low-to-mid level claims, ensuring correct benefits and adjudication per standards.

Candidates should have at least 5 years of claims management, a HS diploma (Bachelor's preferred), and may pursue professional certifications. Sedgwick offers flexible schedules, growth, and comprehensive benefits.

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

Job description

Sedgwick in the United States seeks a full-time Claims Examiner for Workers' Compensation (AK jurisdiction) with remote work options. This role processes low-to-mid level claims, ensuring correct benefits and adjudication per standards.

Candidates should have at least 5 years of claims management, a HS diploma (Bachelor's preferred), and may pursue professional certifications. Sedgwick offers flexible schedules, growth, and comprehensive benefits.