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. Qualifications 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. Licensing & Jurisdiction Knowledge Knowledge of relevant state workers compensation laws and regulations. License to practice claims adjudication as required by state (if applicable). Benefits 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. Legal & EEO Statements Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. #J-18808-Ljbffr