Claims Adjuster - Workers Compensation

📋 Description

• • Embark on a meaningful career journey with Sedgwick, a global leader in claims management, where you'll join a dedicated team of over 33,000 colleagues committed to supporting individuals through life's unexpected challenges.
• • As a Claims Adjuster specializing in Workers' Compensation, you will play a pivotal role in the meticulous processing of low-level claims, ensuring that benefits are accurately determined and disbursed according to established standards and best practices.
• • Your primary responsibility will be to manage the end-to-end adjudication of workers' compensation claims, from initial assessment to final resolution, with a focus on efficiency and compliance.
• • You will be instrumental in identifying potential subrogation opportunities, proactively pursuing recovery of funds where applicable, and skillfully negotiating settlements to achieve favorable outcomes for both the claimant and the company.
• • A key aspect of this role involves developing and coordinating comprehensive action plans for each claim, guiding them towards a successful resolution, and actively supporting return-to-work efforts for injured employees.
• • You will be empowered to approve and process assigned claims, meticulously determining the benefits due, and administering the claim's action plan in strict adherence to the claim's specific circumstances or client contract requirements.
• • Maintaining the integrity of claim files is paramount; you will ensure all documentation is complete, accurate, and properly filed, and that all claims coding is correct to reflect the claim's status and progression.
• • For specific claims, you may also be tasked with managing low-level lifetime medical and/or defined period medical claims, which involves navigating state-specific filings, understanding utilization review decisions, and approving appropriate medical treatments.
• • Cultivating and maintaining professional, positive relationships with clients will be a continuous effort, ensuring clear communication and fostering trust in Sedgwick's capabilities.
• • You will be expected to monitor reserve accuracy throughout the claims process, making necessary adjustments to ensure financial projections are sound and aligned with claim developments.
• • Filing necessary documentation with state agencies will be a regular duty, ensuring compliance with all regulatory requirements and deadlines.
• • This role requires a proactive approach to claim management, anticipating needs, and implementing solutions to ensure timely and equitable claim resolution.
• • You will contribute to the organization's overarching quality programs, actively participating in initiatives aimed at continuous improvement in claims handling and customer service.
• • While primarily a remote position, there may be occasional travel requirements, necessitating flexibility and adaptability.
• • The role demands excellent analytical and interpretive skills to assess complex claim situations, make sound judgments, and develop effective strategies.
• • Strong organizational skills are essential for managing a caseload of claims, prioritizing tasks, and meeting deadlines consistently.
• • You will be expected to communicate effectively, both orally and in writing, with claimants, clients, medical providers, and internal stakeholders, often requiring presentation skills.
• • A collaborative spirit is vital, as you will work within a team environment, sharing knowledge and supporting colleagues to achieve collective success.
• • Meeting and exceeding service expectations will be a core performance metric, reflecting Sedgwick's commitment to exceptional customer care.
• • You will leverage your developing knowledge of relevant regulations, offsets, deductions, disability duration, medical management practices, and Social Security and Medicare application procedures to effectively manage claims.
• • Proficiency in PC usage, including Microsoft Office Suite, will be necessary for daily tasks, documentation, and communication.
• • This position offers the opportunity to grow your career within a supportive and award-winning company culture, recognized for its commitment to employee well-being and work-life balance.