Claims Examiner - Workers Compensation

Sedgwick

Claims Examiner managing complex water damage claims for Sedgwick. Analyzing, negotiating, and ensuring timely adjudication of claims in a supportive environment.

Posted 6/14/2026full-timeRemote • Tennessee • 🇺🇸 United StatesMid-LevelSeniorWebsite

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

claims managementliability assessmentclaims processingnegotiationclaims codingsubrogationmedical claims processingaction plan managementdocumentation

Soft Skills

communicationrelationship management

Industry Keywords

water damage claimsclaims paymentsquality programutilization reviewclient contract

About the role

Key responsibilities & impact

Manages mid-level water damage claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
Assesses liability and resolves claims within evaluation.
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.
Performs other duties as assigned.
Supports the organization's quality program(s).

Requirements

What you’ll need

4 years of Liability claims management experience or equivalent combination of education and experience required.
Bachelor's degree from an accredited college or university preferred.

Benefits

Comp & perks

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.