Claims Adjuster – Workers Comp

🕒 May 28

☕ Washington – Remote

☕ Washington – Remote

💵 $68k - $80k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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Sedgwick

WebsiteLinkedInAll Job Openings

10,000+ employees

🏢 Enterprise

📋 Compliance

Insurance • Enterprise • Compliance

Sedgwick is a global provider of technology-enabled risk, benefits, and integrated business solutions. They help people and organizations by managing and mitigating risk with solutions in accident, health, disability, unemployment compensation, and liability claims administration, among others. Sedgwick offers services such as claims administration, building consulting, forensic accounting, and forensic engineering. Their specialties include property restoration, brand protection, and loss prevention across several industries, including agriculture, construction, and environmental sectors. The company emphasizes diversity, equity, and inclusion (DEI) as well as environmental, social, and governance (ESG) practices.

📋 Description

• To analyze mid- and higher-level workers compensation claims to determine benefits due; • to ensure ongoing adjudication of claims within company standards and industry best practices; • and to identify subrogation of claims and negotiate settlements. • Manage workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency. • Develop and manage 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.

🎯 Requirements

• Bachelor's degree from an accredited college or university preferred. • Four (4) years of claims management experience or equivalent combination of education and experience required. • Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business. • Excellent oral and written communication, including presentation skills. • PC literate, including Microsoft Office products. • Analytical and interpretive skills. • Strong organizational skill. • Good interpersonal skills. • Excellent negotiation skills. • Ability to work in a team environment. • Ability to meet or exceed Service Expectations.

🏖️ Benefits

• Three Medical, and two dental plans to choose from. • Tuition reimbursement eligible. • 401K plan that matches 50% on every $ you put in up to the first 6% you save. • 4 weeks PTO your first full year.