Sedgwick is looking for a Claims Adjuster - Workers' Compensation to analyze mid- and higher-level claims. In this role, you will ensure claims adjudication aligns with company standards and industry best practices while managing cases to a timely and accurate resolution.
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 state agencies.
- Develop and manage action plans to resolve workers compensation claims.
- Coordinate return-to-work efforts and approve claim payments.
- Process assigned claims, determine benefits due, and manage action plans pursuant to contracts.
- 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.
- Process complex lifetime medical and/or defined period medical claims, including 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
- 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 on day one.
Work Mode
This is a remote position. Candidates must have experience handling claims for North Carolina, South Carolina, and/or Virginia.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
