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Claims Adjuster - Workers Compensation | Jurisdiction: MI, TX, IN, IL, OH | Licensing: Required - Remote

Sedgwick Claims Management Services, Inc.

Job Overview

Location

6 Locations

Job Type

Full-time

Full Job Description

📋 Description

• Adjudicate complex workers compensation claims to determine compensability and benefits due, focusing on long-term indemnity claims.
• Monitor and ensure accuracy of claim reserves in alignment with company standards and industry best practices.
• Develop and manage comprehensive action plans for claims to achieve timely resolution, including coordination of return-to-work efforts.
• Approve and process assigned claims, determining appropriate benefit payments based on claim specifics and client contract terms.
• Manage subrogation opportunities, including identification, negotiation, and settlement of third-party recovery claims.
• Communicate clearly and professionally with claimants and clients regarding claim status, decisions, and next steps.
• Ensure all claim files are accurately documented with correct coding and complete regulatory filings as required by state agencies.
• Process complex lifetime medical and defined-period medical claims, including review of utilization review recommendations and state/physician filings.
• Maintain professional relationships with clients to ensure service quality and compliance with contractual obligations.
• File necessary documentation with state workers compensation agencies in jurisdictions including MI, TX, IN, IL, and OH.
• Apply knowledge of state-specific workers compensation laws and regulations applicable to assigned jurisdictions.
• Handle multiple priorities simultaneously while meeting strict deadlines and maintaining high standards of accuracy.
• Demonstrate strong analytical, problem-solving, and decision-making skills in evaluating medical treatment necessity and benefit entitlement.
• Utilize computer systems to manage claims data, document actions, and maintain compliance with internal and external reporting requirements.
• Perform keyboarding and computer-based tasks as primary physical requirements for daily responsibilities.
• Operate in a remote work environment with flexibility in scheduling, while maintaining consistent communication and performance standards.

🎯 Requirements

• Four (4) years of claims management experience or equivalent combination of education and experience required.
• Professional licensing in home state required (MI, TX, IN, IL, or OH).
• Jurisdiction knowledge of MI, TX, IN, IL, and OH workers compensation laws and regulations required.

🏖️ Benefits

• Flexible work schedule.
• Referral incentive program.
• Career development and promotional growth opportunities.
• Comprehensive benefits offering including medical, dental, vision, 401K on day one, PTO, disability and life insurance, employee assistance, and flexible spending or health savings accounts.
• Opportunity to work in an agile environment.

Skills & Technologies

Design

Remote

Degree Required

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Sedgwick Claims Management Services, Inc.

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About Sedgwick Claims Management Services, Inc.

Sedgwick is a global provider of technology-enabled risk, benefits and integrated business solutions, primarily handling insurance claims, managed care, absence and disability, and productivity management for employers, carriers, and administrators. The company processes millions of claims annually across workers' compensation, property, casualty, disability, and other lines, leveraging analytics and digital platforms to improve outcomes, reduce costs, and enhance customer and employee experiences.

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