Remote Workers' Compensation Claims Specialist

Sedgwick; Lincoln (NE); Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Agile environment

Career development

Benefits: medical, dental, vision, 401

Job summary

Sedgwick is seeking a Claims Adjuster - Workers Compensation for remote work across MI, TX, IN, IL, OH. You will adjudicate complex workers compensation claims, determine benefits, monitor reserves, and coordinate settlements in an energetic, collaborative environment.

The ideal candidate has a Bachelor's degree and 4 years of claims management experience, with licensing in your home state and knowledge of jurisdiction-specific rules.

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 which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

Education

Bachelor's degree

Job description

Sedgwick is seeking a Claims Adjuster - Workers Compensation for remote work across MI, TX, IN, IL, OH. You will adjudicate complex workers compensation claims, determine benefits, monitor reserves, and coordinate settlements in an energetic, collaborative environment.

The ideal candidate has a Bachelor's degree and 4 years of claims management experience, with licensing in your home state and knowledge of jurisdiction-specific rules.