Remote Workers' Compensation Claims Specialist

Sedgwick; Helena (MT); Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentive program

Career development

Job summary

Sedgwick is seeking a Claims Adjuster - Workers Compensation to analyze mid- to high-level claims and determine benefits due, while adjudicating claims per company standards and industry best practices. Remote work options apply in multiple jurisdictions.

The ideal candidate has a bachelor’s degree and at least four years of claims management experience, with licensing to work in a home state and knowledge of MI, TX, IN, IL, and OH.

Qualifications

• Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business 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 adjudication

Negotiation

Documentation

Education

Bachelor's degree

Professional certification (as applicable)

Job description

Sedgwick is seeking a Claims Adjuster - Workers Compensation to analyze mid- to high-level claims and determine benefits due, while adjudicating claims per company standards and industry best practices. Remote work options apply in multiple jurisdictions.

The ideal candidate has a bachelor’s degree and at least four years of claims management experience, with licensing to work in a home state and knowledge of MI, TX, IN, IL, and OH.