Claims Adjuster - Workers Compensation

Responsibilities

• Manages workers compensation claims determining compensability and benefits due on long-term indemnity claims, monitors reserve accuracy, and files necessary documentation with the state agency.
• Develops and manages 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 plans 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.

• Bachelor’s degree from an accredited college or university preferred.
• Professional certification applicable to line of business preferred.
• Four (4) years of claims management experience or an equivalent combination of education and experience required.

• Knowledge of relevant state workers compensation laws and regulations.
• License to practice claims adjudication as required by state (if applicable).

• Flexible work schedule.
• Referral incentive program.
• Opportunity to work in an agile environment.
• Career development and promotional growth opportunities.
• Diverse and comprehensive benefits including medical, dental, vision, and 401(k) on day one.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.