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Sedgwick

Sedgwick, headquartered in Memphis, Tennessee, provides a global clientele with technology-enabled risk and benefits solutions. Distinguished as an Employer of

Claims Adjuster – Workers Compensation

Claims SpecialistClaims SpecialistFull TimeRemoteSeniorTeam 10,001Company Site

Location

Washington

Posted

40 days ago

Salary

Not specified

Seniority

Senior

Bachelor Degree4 yrs expEnglish

Job Description

• To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements. • 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).

Job Requirements

  • Bachelor's degree from an accredited college or university preferred.
  • Four (4) years of claims management experience or equivalent combination of education and experience required.
  • Jurisdiction Knowledge: Washington Licensing: Washington

Benefits

  • Flexible work schedule.
  • Referral incentive program.
  • Opportunity to work in an agile environment.
  • Career development and promotional growth opportunities.
  • A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

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