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Claims Adjuster Workers Compensation Specialist
2 months ago
We are seeking a highly skilled and experienced Claims Adjuster Workers Compensation Specialist to join our team at Sedgwick. As a key member of our team, you will be responsible for analyzing and managing workers compensation claims to ensure accurate and timely benefits are provided to our clients.
Key Responsibilities- Analyze and manage workers compensation claims to determine benefits due and ensure ongoing adjudication within company standards and industry best practices.
- Develop and manage claims action plans to resolution, coordinate return-to-work efforts, and approve claim payments.
- Manage subrogation of claims and negotiate settlements.
- Communicate claim action with claimants and clients.
- Ensure claim files are properly documented and claims coding is correct.
- May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
- Maintain professional client relationships.
- Bachelor's degree from an accredited college or university preferred.
- Four (4) years of claims management experience or equivalent combination of education and experience required.
- Working knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business.
- Excellent oral and written communication, including presentation skills.
- PC literate, including Microsoft Office products.
- Analytical and interpretive skills.
- Strong organizational skill.
- Good interpersonal skills.
- Excellent negotiation skills.
- Ability to work in a team environment.
- Ability to meet or exceed Service Expectations.
This role requires the ability to work in a fast-paced environment and meet deadlines. The successful candidate will have excellent analytical and problem-solving skills, as well as strong communication and interpersonal skills. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
