Claims Specialist at Voya guiding claimants through FMLA and other leave experiences. Ensuring high service standards and compliance with regulatory requirements in a remote role.
About the role
- Claims Adjuster analyzing mid- to higher-level workers compensation claims for Sedgwick, a global risk management company. Ensuring claims are adjudicated to company standards and negotiating settlements as needed.
Responsibilities
- 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
- To identify subrogation of claims and negotiate settlements
- Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency
- Develops and manages 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
- Performs other duties as assigned.
- Supports the organization's quality program(s)
- Travels as required
Requirements
- Experience in Workers Compensation Claims handling of TX IL IN MO KS
- 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
Benefits
- Flexible Work Schedule
- Referral Incentive Program
- Opportunity to work from home
- Career development and promotional growth opportunities
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day 1
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