Claims Adjuster - Workers Comp

Claims Adjuster – Workers Comp This role requires direct experience handling Washington (WA) State Workers’ Compensation claims . Candidates must have hands‑on knowledge of WA jurisdictional requirements, including state regulations, filings, and claim adjudication practices.

PRIMARY PURPOSE OF THE ROLE

We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

ARE YOU AN IDEAL CANDIDATE

To analyze Workers’ Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

ESSENTIAL RESPONSIBILITIES

Manage workers compensation claims determining compensability and benefits due on long‑term indemnity claims; monitor reserve accuracy; file necessary documentation with the state agency. Develop and manage workers compensation claims’ action plans to resolution, coordinate return‑to‑work efforts, and approve claim payments. Approve and process assigned claims, determine benefits due, and manage action plans pursuant to the claim or client contract. Manage subrogation of claims and negotiate settlements. Communicate claim action with claimant and client. Ensure claim files are properly documented and claims coding is correct. Process complex 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.

QUALIFICATIONS

Education & Licensing : 4 years of claims management experience or an equivalent combination of education and experience is required. High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

TAKING CARE OF YOU

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

WORK ENVIRONMENT REQUIREMENTS

Physical: Computer keyboarding. Auditory/visual: Hearing, vision, and talking. Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines. As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $68,000 - $80,000. A comprehensive benefits package is offered including but not limited to medical, dental, vision, 401(k) and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace. #J-18808-Ljbffr Sedgwick