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Sedgwick · 15 hours ago

Claims Adjuster - Workers Compensation

Plano, TX

Full-time

Hybrid

Mid Level

4+ years exp

Sedgwick is a global industry leader focused on providing meaningful support to individuals facing unexpected challenges. The Claims Adjuster will adjudicate complex workers compensation claims, ensuring compliance with company standards while delivering exceptional customer service and innovative solutions.

BankingInsuranceRisk Management

Responsibilities

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

Performs other duties as assigned

Supports the organization's quality program(s)

Travels as required