Remote Workers' Comp Claims Examiner

Sedgwick; Santa Fe (NM); Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development opportunities

Comprehensive benefits

Job summary

Sedgwick is seeking a dedicated claims professional to process low-level workers' compensation claims and determine benefits. The role emphasizes adjudication within corporate standards and collaboration with clients and claimants in a remote or office setting.

Ideal candidates will have five years of claims management experience, a HS diploma or GED, and a preferred Bachelor's degree. Sedgwick offers growth, flexible schedules, and a comprehensive benefits package.

Qualifications

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

Responsibilities

• Processes low level workers' compensation claims and determines benefits.
• Develops action plans for resolution and return-to-work; approves claim payments.
• Approves and processes assigned claims per contract.
• Administers subrogation of claims and negotiates settlements.
• Communicates claim actions with claimant and client.
• Ensures claim files are properly documented and coding is correct.
• May process lifetime medical or defined period medical claims as needed.
• Maintains professional client relationships.

Skills

Claims processing

Attention to detail

Communication

Education

High School Diploma or GED

Bachelor's degree preferred

Professional certification where applicable

Job description

Sedgwick is seeking a dedicated claims professional to process low-level workers' compensation claims and determine benefits. The role emphasizes adjudication within corporate standards and collaboration with clients and claimants in a remote or office setting.

Ideal candidates will have five years of claims management experience, a HS diploma or GED, and a preferred Bachelor's degree. Sedgwick offers growth, flexible schedules, and a comprehensive benefits package.