Claims Adjuster

We are seeking a highly skilled Claims Adjuster - Workers Compensation Specialist to join our team at Sedgwick. As a key member of our claims team, you will be responsible for analyzing complex workers' compensation claims, determining benefits due, and ensuring timely and cost-effective claims resolution.

• Analyze and process complex workers' compensation claims, investigating and gathering information to determine exposure and manage claims through well-developed action plans.
• Negotiate settlements within designated authority and calculate and assign timely and appropriate reserves to claims.
• Calculate and pay benefits due, approve and make timely claim payments and adjustments, and settle claims within designated authority level.
• Prepare necessary state filings within statutory limits and manage the litigation process to ensure timely and cost-effective claims resolution.
• Coordinate vendor referrals for additional investigation and/or litigation management and use cost containment techniques to reduce overall cost of claims for our clients.
• Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
• Report claims to the excess carrier and respond to requests and directions in a professional and timely manner.
• Communicate claim activity and processing with the claimant and the client and maintain professional client relationships.
• Ensure claim files are properly documented and claims coding is correct.

• Bachelor's degree from an accredited college or university preferred.
• Five (5) years of claims management experience or equivalent combination of education and experience required.
• Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
• Ability to meet or exceed Service Expectations, work in a team environment, and possess excellent negotiation skills, good interpersonal skills, strong organizational skills, analytical and interpretive skills, and PC literacy.

When applicable and appropriate, consideration will be given to reasonable accommodations. The successful candidate will be required to work in a fast-paced environment, handle multiple priorities simultaneously, and meet deadlines. The position requires clear and conceptual thinking ability, excellent judgment, troubleshooting, problem-solving, analysis, and discretion, as well as the ability to handle work-related stress.