Claims Adjuster - Workers Compensation
Company: Sedgwick
Location: Austin
Posted on: May 26, 2023
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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.
Its an opportunity to do something meaningful, each and every day.
Its 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 youre someone who cares,
theres 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.
+ 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.
**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**
+ 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**
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.**
**Taking care of people is at the heart of everything we do. Caring
counts**
Sedgwick is a leading global provider of technology-enabled risk,
benefits and integrated business solutions. Every day, in every
time zone, the most well-known and respected organizations place
their trust in us to help their employees regain health and
productivity, guide their consumers through the claims process,
protect their brand and minimize business interruptions. Our more
than 30,000 colleagues across 80 countries embrace our shared
purpose and values as they demonstrate what it means to work for an
organization committed to doing the right thing one where caring
counts. Watch this video to learn more about us.
(https://www.youtube.com/watch?v=ywxedjBGSfA)
Keywords: Sedgwick, Austin , Claims Adjuster - Workers Compensation, Other , Austin, Texas
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