Claims Adjuster - Workers Compensation | Jurisdiction: MI, TX, IN, IL, OH | Licensing: Required - Remote

Sedgwick•Alley, MO

6d•$60,000 - $75,000•Remote

About The Position

The Claims Adjuster analyzes mid- and higher-level workers compensation claims to determine benefits due, ensures ongoing adjudication within company standards and industry best practices, identifies subrogation opportunities, and negotiates settlements. The role manages claims through resolution, including compensability decisions, reserve monitoring, documentation, return-to-work coordination, and claim payments. The position covers the jurisdictions of Michigan, Texas, Indiana, Illinois, and Ohio, and requires a home-state license.

Requirements

Four years of claims management experience or an equivalent combination of education and experience.
Home-state license required.
Jurisdiction knowledge for Michigan, Texas, Indiana, Illinois, and Ohio.

Nice To Haves

Bachelor's degree from an accredited college or university.
Professional certification, as applicable to the line of business.

Responsibilities

Manage workers compensation claims, determining compensability and benefits due on long-term indemnity claims.
Monitor reserve accuracy and file necessary documentation with state agencies.
Develop and manage claims action plans through 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 claim subrogation and negotiate settlements.
Communicate claim actions with claimants and clients.
Ensure claim files are properly documented and claims coding is correct.
As applicable, process complex lifetime medical and/or defined-period medical claims, including state and physician filings and decisions on treatments recommended by utilization review.
Maintain professional client relationships.