Workers' Compensation Claims Advocate | Flexible Hybrid Role

Sedgwick Claims Management Services Inc.; United States; Remote; USD 73.000 - 85.000; Vollzeit

Benefits dieser Stelle

Flexible schedule

Referral incentives

Career development

Full benefits

Zusammenfassung

Sedgwick Claims Management Services Inc. in California seeks a Workers' Compensation Claims Adjuster to analyze mid- to long-term workers' compensation claims and determine benefits due, ensuring adjudication aligns with state laws and company standards.

You will manage subrogation, coordinate return-to-work efforts, communicate with claimants and clients, and maintain accurate documentation while striving for timely resolutions.

Qualifikationen

• Bachelor's degree from an accredited college or university preferred.
• Four (4) years of California Workers Compensation claims management experience or equivalent combination of education and experience required.
• California jurisdictional knowledge required; SIP required or must be obtained within one (1) year of employment.

Aufgaben

• 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.

Kenntnisse

California WC knowledge

Claims adjudication

Client communication

Ausbildung

Bachelor's degree

Jobbeschreibung

Sedgwick Claims Management Services Inc. in California seeks a Workers' Compensation Claims Adjuster to analyze mid- to long-term workers' compensation claims and determine benefits due, ensuring adjudication aligns with state laws and company standards.

You will manage subrogation, coordinate return-to-work efforts, communicate with claimants and clients, and maintain accurate documentation while striving for timely resolutions.