Claims Adjuster – Workers Compensation

🕒 September 10

🏈 Alabama, North Carolina, +2 more states – Remote

🏈 Alabama – Remote 🌲 North Carolina – Remote 🚗 Michigan – Remote 🤠 Texas – Remote

💵 $60k - $85k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 25%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Sedgwick

WebsiteLinkedInAll Job Openings

10,000+ employees

🏗️ Construction

💼 Consulting

🏥 Healthcare

Construction • Consulting • Healthcare

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

• Analyze mid- and higher-level workers compensation claims to determine benefits due • Ensure ongoing adjudication of claims within company standards and industry best practices • Identify subrogation opportunities and negotiate settlements • Manage workers compensation claims, compensability determinations, benefits, reserves, and state-agency filings • Develop and manage claim action plans through resolution • Coordinate return-to-work efforts and approve claim payments • Process assigned claims and manage action plans according to claim or client contracts • Communicate claim actions with claimants and clients • Ensure claim files are properly documented and claims coding is correct • Process complex lifetime medical or defined-period medical claims, including state and physician filings and treatment decisions • Maintain professional client relationships

🎯 Requirements

• Bachelor's degree from an accredited college or university preferred • Professional certification as applicable to line of business preferred • Four (4) years of claims management experience or equivalent combination of education and experience required • Knowledge of TX, MN, and MI jurisdictions • TX licensing required, or home-state licensing for remote work • Ability to analyze claims, determine compensability and benefits due, and manage reserves • Ability to file necessary documentation with state agencies • Ability to manage workers compensation claims through resolution • Ability to coordinate return-to-work efforts and approve claim payments • Ability to manage subrogation claims and negotiate settlements • Ability to maintain accurate claim documentation and coding • Ability to process complex medical claims involving state and physician filings • Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion • Ability to handle work-related stress, multiple priorities, and deadlines

🏖️ Benefits

• Flexible work schedule • Referral incentive program • Opportunity to work in an agile environment • Career development and promotional growth opportunities • Medical, dental, and vision benefits • 401K and matching on day one • Paid time off (PTO) • Disability and life insurance • Employee assistance • Flexible spending or health savings account • Other additional voluntary benefits