Claims Representative - Workers Compensation | Jurisdiction: AK | Licensing: AK - Remote

Sedgwick Claims Management Services, Inc.

Job Overview

Location

2 Locations

Job Type

Full-time

Full Job Description

📋 Description

• Process low-level workers compensation claims to determine compensability and benefits due on long-term indemnity claims, ensuring adherence to company standards and industry best practices.
• Monitor and maintain reserve accuracy for assigned claims and file necessary documentation with state agencies in accordance with Alaska jurisdiction requirements.
• Develop and coordinate action plans for claims resolution, including return-to-work efforts and approval of claim payments under general supervision.
• Administer subrogation processes and negotiate settlements on claims to recover costs from third parties.
• Communicate directly with claimants and clients regarding claim status, decisions, and required actions.
• Ensure all claim files are accurately documented and properly coded in accordance with internal and regulatory standards.
• Process low-level lifetime medical and defined-period medical claims, including reviewing physician-recommended treatments and making decisions based on utilization review outcomes.
• Complete state and physician filings required for medical claim adjudication in Alaska.
• Maintain professional relationships with clients to ensure service quality and compliance with client contracts.
• Operate in a stable, consistent office setting with structured workflows and clear procedural guidelines.
• Handle multiple priorities simultaneously while meeting strict deadlines and managing work-related stress effectively.
• Utilize computer systems for data entry, claim tracking, and documentation, requiring proficient keyboarding skills.
• Apply clear conceptual thinking, sound judgment, problem-solving, and analytical skills to evaluate claim details and make determinations.
• Demonstrate empathy, accountability, collaboration, growth, and inclusion in all interactions with claimants, clients, and colleagues.
• Adhere to all licensing and jurisdictional requirements specific to Alaska workers compensation regulations.
• Participate in an agile work environment that supports continuous improvement and operational efficiency.
• Engage in career development opportunities and promotional growth paths within the claims management field.

🎯 Requirements

• High School Diploma or GED required
• 2 years of claims management experience or equivalent combination of education and experience
• Active Alaska workers compensation licensing required

🏖️ Benefits

• Flexible work schedule
• Referral incentive program
• Career development and promotional growth opportunities
• Comprehensive benefits package including medical, dental, vision, 401(k) on day one, PTO, disability and life insurance, employee assistance program, and flexible spending or health savings accounts
• Opportunity to work in an agile environment
• Reasonable accommodations considered when applicable

Skills & Technologies

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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