Sedgwick is looking for a Claims Adjuster - Workers Compensation to analyze and manage mid- and higher-level workers compensation claims. You will determine benefits due, ensure ongoing adjudication aligns with company standards and industry best practices, and identify subrogation opportunities.
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 agency.
- Develop and manage workers compensation claims' action plans to resolution.
- Coordinate return-to-work efforts and approve claim payments.
- Approve and process assigned claims, determine benefits due, and manage action plan pursuant to the claim or client contract.
- Manage subrogation of claims and negotiate settlements.
- Communicate claim action with claimant and client.
- Ensure 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.
- Maintain professional client relationships.
- Support the organization's quality program(s).
- Travel as required.
What We're Looking For
- Four (4) years of claims management experience or equivalent combination of education and experience required.
Nice to Have
- Bachelor's degree from an accredited college or university preferred.
Benefits & Compensation
- Compensation: $50,000 - $65,000
- Medical, dental, vision insurance
- 401k and matching
- PTO
- Disability and life insurance
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
Work Mode
This position is remote and open to candidates located in Colorado.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
