Claims Adjuster

Sedgwick

20h•Onsite

About The Position

Sedgwick is seeking a Claims Adjuster to analyze mid- and higher-level workers compensation claims to determine benefits due. The role involves ensuring ongoing adjudication of claims within company standards and industry best practices, and identifying subrogation of claims and negotiating settlements. Sedgwick is a global leader in risk and claims administration, committed to providing caring solutions and fostering a positive work environment.

Requirements

Four (4) years of claims management experience or equivalent combination of education and experience required.
Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skill
Good interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Service Expectations

Nice To Haves

Bachelor's degree from an accredited college or university preferred.

Responsibilities

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.