Claims Adjuster - Workers Compensation | Jurisdiction: TX, MN, MI | Licensing: TX or Home State required - Remote

Sedgwick•Alley, MO

12d•$60,000 - $85,000•Remote

About The Position

The Claims Adjuster analyzes mid- and higher-level workers compensation claims to determine benefits due, ensure ongoing adjudication within company standards and industry best practices, identify subrogation opportunities, and negotiate settlements. The role manages claim action plans through resolution, coordinates return-to-work efforts, approves payments, communicates claim decisions and actions to claimants and clients, and maintains professional client relationships. The position covers the TX, MN, and MI jurisdictions and requires TX or home-state licensing.

Requirements

Four years of claims management experience or an equivalent combination of education and experience.
Knowledge of the TX, MN, and MI jurisdictions.
TX or home-state licensing is required.
Ability to think clearly and conceptually and demonstrate excellent judgment, troubleshooting, problem-solving, analysis, and discretion.
Ability to handle work-related stress, manage multiple priorities simultaneously, and meet deadlines.
Ability to perform computer keyboarding, travel as required, and meet hearing, vision, and talking demands.

Nice To Haves

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

Responsibilities

Manage workers compensation claims, determine compensability and benefits due on long-term indemnity claims, monitor reserve accuracy, and file necessary documentation with state agencies.
Develop and manage claim action plans through resolution, coordinate return-to-work efforts, and approve claim payments.
Approve and process assigned claims, determine benefits due, and manage the action plan pursuant to the claim or client contract.
Manage subrogation of claims and negotiate settlements.
Communicate claim actions with claimants and clients.
Ensure claim files are properly documented and claims coding is correct.
Process complex lifetime medical and/or defined-period medical claims when applicable, including state and physician filings and decisions on treatments recommended by utilization review.
Maintain professional client relationships.