Remote Workers' Comp Claims Specialist

Sedgwick; Jackson (MS); Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

401k and matching

PTO

Job summary

Sedgwick is seeking a Claims Adjuster for Workers' Compensation to analyze mid- and higher-level claims, determine benefits, and adjudicate according to standards. The role requires handling subrogation, settlements, and state-specific processes while maintaining client relationships.

The ideal candidate will have a Bachelor's degree and four years of claims management experience, with knowledge across MI, TX, IN, IL, and OH, plus Home State licensing.

Qualifications

• Bachelor's degree preferred.
• Four (4) years of claims management experience or equivalent combination of education and experience required.
• Jurisdiction knowledge: MI, TX, IN, IL, OH.
• Licensing: Home State Required.

Responsibilities

• Manages 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 manages workers compensation claims’ action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
• Manages 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 complex 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

Adjudication

Subrogation

Communication

Education

Bachelor's degree

Job description

Sedgwick is seeking a Claims Adjuster for Workers' Compensation to analyze mid- and higher-level claims, determine benefits, and adjudicate according to standards. The role requires handling subrogation, settlements, and state-specific processes while maintaining client relationships.

The ideal candidate will have a Bachelor's degree and four years of claims management experience, with knowledge across MI, TX, IN, IL, and OH, plus Home State licensing.