Remote Workers' Compensation Claims Specialist

Sedgwick; Honolulu (HI); Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Flexible schedule

Referral program

Agile environment

Career development

Job summary

Sedgwick is seeking a Claims Adjuster - Workers' Compensation to analyze mid- to high-level claims and determine benefits due, with a focus on timely adjudication and subrogation where appropriate. This remote role supports jurisdictions MI, TX, IN, IL, and OH.

You will work in a collaborative environment, manage complex claims through resolution, and contribute to a culture that values empathy, accountability, and growth while offering flexible work options and a comprehensive benefits package.

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.
• 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 including state and physician filings and decisions on treatments.

Education

Bachelor's degree

Professional certification related to line of business

Job description

Sedgwick is seeking a Claims Adjuster - Workers' Compensation to analyze mid- to high-level claims and determine benefits due, with a focus on timely adjudication and subrogation where appropriate. This remote role supports jurisdictions MI, TX, IN, IL, and OH.

You will work in a collaborative environment, manage complex claims through resolution, and contribute to a culture that values empathy, accountability, and growth while offering flexible work options and a comprehensive benefits package.