Analyze Workers Compensation claims for clients to determine benefits due while ensuring ongoing adjudication within service expectations. Collaborate to deliver innovative customer - facing solutions within an energetic culture.
About the role
- Claims Adjuster analyzing mid- and higher-level workers compensation claims for Sedgwick. Ensuring proper adjudication and negotiating settlements within company standards.
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
- Approves claim payments
- 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.
- Maintains professional client relationships.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
Requirements
- 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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