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Claims Adjuster - Workers Compensation

Company

Sedgwick

Address , Marlton, Nj
Employment type
Salary
Expires 2023-07-18
Posted at 1 year ago
Job Description
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work®
Most Loved Workplace®
Forbes Best-in-State Employer
Claims Adjuster - Workers Compensation
PRIMARY PURPOSE: 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.
ESSENTIAL FUNCTIONS and 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.
  • Communicates claim action with claimant and client.
  • Manages subrogation of claims and negotiates settlements.
  • Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
  • Maintains professional client relationships.
  • 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.
  • Ensures claim files are properly documented and claims coding is correct.
  • Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
  • Performs other duties as assigned.
  • Supports the organization's quality program(s).
  • Travels as required.
QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university preferred.
Experience
Four (4) years of claims management experience or equivalent combination of education and experience required.
Skills & Knowledge
  • Excellent negotiation skills
  • Analytical and interpretive skills
  • Excellent oral and written communication, including presentation skills
  • Strong organizational skill
  • Ability to meet or exceed Service Expectations
  • 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
  • PC literate, including Microsoft Office products
  • Good interpersonal skills
  • Ability to work in a team environment
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.