Remote Workers' Comp Claims Examiner

Sedgwick; Montpelier (VT); Remote; USD 75,000 - 90,000; Full time

Job summary

Sedgwick is seeking a Claims Examiner for Workers' Compensation with AK jurisdiction and remote work options. You will process low level claims, determine benefits, and manage adjudication within company standards.

This role emphasizes subrogation, return-to-work planning, and client communication, with a focus on accuracy and professional relationships. A HS diploma and 5 years of claims experience are required; a Bachelor's or professional certifications are preferred.

Qualifications

• 5 years of claims management experience or equivalent combination of education and experience.
• 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 handling

Attention to detail

Communication

Team collaboration

Education

High School Diploma or GED

Bachelor's degree

Professional certification

Job description

Sedgwick is seeking a Claims Examiner for Workers' Compensation with AK jurisdiction and remote work options. You will process low level claims, determine benefits, and manage adjudication within company standards.

This role emphasizes subrogation, return-to-work planning, and client communication, with a focus on accuracy and professional relationships. A HS diploma and 5 years of claims experience are required; a Bachelor's or professional certifications are preferred.