Workers Compensation Claims Adjuster
Sedgwick
full-time
Posted on:
Location Type: Hybrid
Location: Roseville • California • United States
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Salary
💰 $60,000 - $80,000 per year
About the role
- To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.
- Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
- Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
- Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
- Manages subrogation of claims and negotiates settlements.
- Communicates claim action with claimant and client.
- Ensures 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.
- Maintains professional client relationships.
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.
- SIP required or must be obtained within one (1) year of employment; California workers compensation jurisdictional knowledge required.
Benefits
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental, vision, 401K on day one.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims managementworkers compensation claims analysisnegotiationsubrogationbenefits determinationreserve accuracy monitoringdocumentation filingaction plan developmentreturn-to-work coordinationclaims coding
Soft Skills
communicationrelationship management
Certifications
SIP