Claims Adjuster – Workers Compensation

🔥 13 hours ago

🏈 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 0%

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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 claims and negotiate settlements • Manage workers compensation claims, including compensability, benefits, reserves, and required state-agency documentation • Develop and manage claims 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 and/or defined-period medical claims when applicable, 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 workers compensation jurisdictions: TX, MN, MI • TX licensing required, or home state licensing required for remote work • Ability to analyze claims and determine compensability and benefits due • Clear and conceptual thinking ability • Excellent judgment, troubleshooting, problem solving, analysis, and discretion • Ability to handle work-related stress and multiple priorities simultaneously • Ability to meet deadlines • Computer keyboarding • Travel as required

🏖️ Benefits

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