Remote Workers' Comp Claims Examiner

Sedgwick; San Juan (PR); Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development opportunities

Job summary

Sedgwick in the United States is seeking a Claims Examiner - Workers' Compensation for AK jurisdiction, potentially remote. You will process low-level WC claims, determine benefits due, and support adjudication within company standards and industry best practices.

Ideal candidates have strong attention to detail, ability to work independently, and a commitment to our caring culture. The role offers a stable office-like environment with flexible scheduling, benefits from day one, and

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.

Skills

Claims management

Communication

Analytical thinking

Education

High School Diploma or GED

Bachelor's degree preferred

Job description

Sedgwick in the United States is seeking a Claims Examiner - Workers' Compensation for AK jurisdiction, potentially remote. You will process low-level WC claims, determine benefits due, and support adjudication within company standards and industry best practices.

Ideal candidates have strong attention to detail, ability to work independently, and a commitment to our caring culture. The role offers a stable office-like environment with flexible scheduling, benefits from day one, and