Remote Workers' Comp Claims Specialist

Sedgwick; Trenton (NJ); Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Agile environment

Career development

Medical, dental, vision, 401k

Job summary

Sedgwick is seeking a Claims Adjuster - Workers' Compensation for a remote role in the United States. You will analyze mid- to high-level workers' compensation claims to determine benefits due, manage subrogation, and negotiate settlements in line with company standards and best practices.

The ideal candidate holds a Bachelor's degree and at least 4 years of claims management experience; licensing must be current in the home state, with knowledge of MI, TX, IN, IL, OH.

Qualifications

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

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

Analytical thinking

Communication

Teamwork

Education

Bachelor's degree

Job description

Sedgwick is seeking a Claims Adjuster - Workers' Compensation for a remote role in the United States. You will analyze mid- to high-level workers' compensation claims to determine benefits due, manage subrogation, and negotiate settlements in line with company standards and best practices.

The ideal candidate holds a Bachelor's degree and at least 4 years of claims management experience; licensing must be current in the home state, with knowledge of MI, TX, IN, IL, OH.