Claims Representative - Workers Compensation | Jurisdiction: Multi State | TX​/FL​/OK​/LA License

Claims Representative – Workers Compensation

Join Sedgwick and help adjudicate workers compensation claims across multiple states while supporting a global team that values empathy, accountability, collaboration, growth, and inclusion.

This position follows a hybrid work model for candidates residing within a 25‑mile radius of a Sedgwick office. Employees in this range will be expected to commute to the office on a hybrid schedule. Candidates located outside of this radius will be considered for a fully remote arrangement.

• Process low‑level workers compensation claims to determine compensability and benefits due, monitor reserve accuracy, and file required documentation with state agencies.
• Develop and coordinate low‑level workers compensation claims’ action plans to resolution, return‑to‑work efforts, and approve claim payments.
• Approve and process assigned claims, administer action plans, and ensure compliance with client contracts.
• Administer subrogation of claims and negotiate settlements.
• Communicate claim action with the claimant and client.
• Ensure claim files are properly documented and claims coding is correct.
• Process low‑level lifetime medical and/or defined period medical claims, including state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintain professional client relationships and perform other duties as assigned.
• Support the organization’s quality program(s) and travel as required.

• Bachelor’s degree from an accredited college or university preferred.
• Two (2) years of claims management experience or equivalent combination of education and experience, or successful completion of claims representative training.
• Multi‑state jurisdiction: 15 states.
• Licensing:
  Texas, Florida, Oklahoma, Louisiana preferred.

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

If you’re excited about this role but your experience doesn’t align perfectly with every qualification, consider applying anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.