Remote Workers' Comp Claims Examiner — Grow & Impact

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

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development

Job summary

Sedgwick is seeking a Claims Examiner for Workers’ Compensation, based remotely in AK. The role focuses on processing low-level claims, determining benefits, and coordinating action plans with limited supervision.

Ideal candidates have 5+ years of claims management experience, a high school diploma (Bachelor’s preferred), and professional certification where applicable. The job offers a stable environment, growth, and a supportive team culture.

Qualifications

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

Remote work

Education

High School Diploma or GED

Bachelor's degree preferred

Professional certification

Job description

Sedgwick is seeking a Claims Examiner for Workers’ Compensation, based remotely in AK. The role focuses on processing low-level claims, determining benefits, and coordinating action plans with limited supervision.

Ideal candidates have 5+ years of claims management experience, a high school diploma (Bachelor’s preferred), and professional certification where applicable. The job offers a stable environment, growth, and a supportive team culture.