Workers Compensation Claims Adjuster
hace 2 semanas
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague.
A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve.
If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here.
Join us and contribute to Sedgwick being a great place to work.Great Place to Work
Most Loved Workplace
Forbes Best-in-State Employer
Workers Compensation Claims Adjuster
PRIMARY PURPOSE:
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.
ESSENTIAL FUNCTIONS and 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 returntowork 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.
QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university preferred.
Experience
Four (4) years of claims management experience or equivalent combination of education and experience required.
Skills & Knowledge
- 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
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental:
Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical:
Computer keyboarding, travel as required
Auditory/Visual:
Hearing, vision and talking
NOTE:
Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
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