Sedgwick is seeking a remote Claims Adjuster - Workers' Compensation with experience in North Carolina, South Carolina, and Virginia. You will analyze mid- to higher-level workers' compensation claims to determine benefits due and ensure proper adjudication while identifying subrogation opportunities and negotiating settlements.
What You'll Do
- Manage workers' compensation claims, determining compensability and benefits due on long-term indemnity claims.
- Monitor reserve accuracy and file necessary documentation with the state agency.
- Develop and manage action plans to bring claims to resolution.
- Coordinate return-to-work efforts and approve claim payments.
- Approve and process assigned claims, determining benefits due per the claim or client contract.
- Manage subrogation of claims and negotiate settlements.
- Communicate claim actions with claimants and clients.
- Ensure claim files are properly documented and claims coding is correct.
- May process complex lifetime medical or defined period medical claims involving state and physician filings.
- Maintain professional client relationships.
- Support the organization's quality programs.
- Travel as required.
What We're Looking For
- 3-4 years of Workers' Compensation claims management experience or an equivalent combination of education and experience.
Nice to Have
- A Bachelor's degree from an accredited college or university.
Benefits & Compensation
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental, vision, and 401K coverage starting on day one.
Work Mode
This is a remote position open to candidates with experience in North Carolina, South Carolina, and Virginia.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
