Claims Examiner - Workers Compensation | Southeast Jurisdictions | Remote
Job Overview
Location
Telecommuter TN
Job Type
Full-time
Category
Software Engineering
Date Posted
June 14, 2026
Full Job Description
đź“‹ Description
- • Adjudicate complex workers' compensation claims within Southeast jurisdictions, determining benefits due and ensuring compliance with state regulations and client-specific requirements.
- • Manage mid-level claims by gathering factual information to assess liability exposure, assign appropriate reserve values, and process payments within designated authority limits.
- • Evaluate and resolve claims involving litigation, rehabilitation, lifetime medical care, and defined-period medical treatments, including review of utilization review recommendations and physician filings.
- • Identify, pursue, and negotiate subrogation opportunities to recover costs from third parties responsible for claim-related damages.
- • Maintain accurate and complete claim documentation, ensuring proper coding and adherence to quality standards and audit requirements.
- • Communicate clearly and professionally with claimants, clients, and third parties regarding claim status, decisions, and required actions.
- • Develop and implement action plans aligned with client contracts and industry best practices for claim resolution and service delivery.
- • Support organizational quality programs by following established protocols and contributing to continuous improvement initiatives.
- • Travel as required to meet claim resolution needs, conduct site visits, or attend meetings with clients or stakeholders.
- • Apply empathy, accountability, collaboration, growth, and inclusion principles in all interactions to uphold Sedgwick’s caring culture.
- • Leverage Sedgwick’s global network of experts to enhance claim handling expertise and share insights across teams.
- • Utilize flexible work arrangements and autonomy to manage daily responsibilities while maintaining high performance and service standards.
- • Engage in professional development opportunities to advance career growth and strengthen technical competencies in workers’ compensation claims.
- • Ensure all claim activities comply with legal, regulatory, and ethical standards while maintaining confidentiality and discretion.
🎯 Requirements
- • 4 years of liability claims management experience or equivalent combination of education and experience
- • Bachelor’s degree from an accredited college or university preferred
- • Experience adjudicating workers’ compensation claims in Southeast U.S. jurisdictions
- • Proven ability to manage high-exposure claims involving litigation and rehabilitation
- • Strong analytical, problem-solving, and decision-making skills
- • Proficiency in claim documentation, coding, and regulatory compliance
🏖️ Benefits
- • Flexible work schedule
- • Referral incentive program
- • Career development and promotional growth opportunities
- • Comprehensive benefits including medical, dental, vision, and 401(k) on day one
Skills & Technologies
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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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