Sedgwick is looking for a Claims Adjuster specializing in Workers Compensation to join our team. In this role, you will analyze mid- and higher-level claims to determine benefits due and ensure adjudication follows best practices. You will deliver innovative customer-facing solutions while managing claims to 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 the state agency.
- Develop and manage action plans for workers compensation claims to bring them to resolution.
- Coordinate return-to-work efforts and approve claim payments.
- Process assigned claims, determine benefits due, and manage action plans per the claim or client contract.
- Manage subrogation of claims and negotiate settlements.
- Communicate claim actions with the claimant and client.
- Ensure claim files are properly documented and claims coding is correct.
- May process complex lifetime medical or defined period medical claims, including state and physician filings and decisions on treatments.
- 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 an equivalent combination of education and experience.
- Experience handling claims in Southeast (SE) states is required.
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 on day one.
Work Mode
This is a remote position requiring experience in Southeast states.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
