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Claims Adjuster

2 months ago

Ontario, California, United States Sedgwick Full time
About the Role

We are seeking a highly skilled Claims Adjuster - Workers Compensation Specialist to join our team at Sedgwick. As a key member of our claims management 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.
Requirements
  • 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.
Work Environment

This role requires a high level of accuracy, attention to detail, and strong analytical skills. The successful candidate will be able to work in a fast-paced environment and meet deadlines while maintaining a high level of professionalism.