Remote Workers' Compensation Claims Examiner

Sedgwick; Bismarck (ND); Remote; USD 75,000 - 90,000; Full time

Benefits offered by this job

Flexible schedule

Referral program

Agile environment

Career development

Comprehensive benefits

Job summary

Sedgwick is seeking motivated individuals to process workers' compensation claims with supervision. You will determine benefits, monitor reserves, and coordinate actions toward resolution while maintaining documentation and client communication.

Ideal candidates bring 5 years of claims experience, a high school diploma or GED, and professional certification where applicable. We offer flexible schedules and a path for growth within a collaborative, inclusive environment.

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

Empathy

Accountability

Collaboration

Growth

Inclusion

Education

High School Diploma or GED

Bachelor's degree preferred

Professional certification preferred

Job description

Sedgwick is seeking motivated individuals to process workers' compensation claims with supervision. You will determine benefits, monitor reserves, and coordinate actions toward resolution while maintaining documentation and client communication.

Ideal candidates bring 5 years of claims experience, a high school diploma or GED, and professional certification where applicable. We offer flexible schedules and a path for growth within a collaborative, inclusive environment.