Workers Compensation Claims Specialist

Join Sedgwick and be part of a meaningful mission. Our 33,000 colleagues work every day to support individuals facing unexpected challenges. We invite you to advance your career in a caring culture that values work-life balance and unlimited potential.

Recognized by Newsweek as one of America's Greatest Workplaces and certified as a Great Place to Work, Sedgwick is also listed among Fortune's Best Workplaces in Financial Services & Insurance.

PRIMARY PURPOSE: To evaluate mid- to higher-level workers compensation claims to determine benefits due, ensure compliance with company standards and industry best practices, and identify claims for subrogation while negotiating settlements.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Manage workers compensation claims, assessing compensability and benefits due on long-term indemnity claims, monitoring reserve accuracy, and filing necessary documentation with state agencies.
• Develop and manage claims action plans, coordinate return-to-work efforts, and approve claim payments.
• Process assigned claims, determine benefits, and adhere to action plans according to claims or client contracts.
• Oversee claim subrogation efforts and negotiate settlements effectively.
• Communicate claim actions clearly with claimants and clients.
• Document claim files thoroughly and ensure accurate coding.
• Handle complex lifetime or defined period medical claims, including state and physician filings and treatment recommendations.
• Maintain professional relationships with clients.

ADDITIONAL FUNCTIONS AND RESPONSIBILITIES

• Perform other duties as assigned.
• Support organizational quality programs.
• Travel as required.

QUALIFICATIONS

Education & Licensing

Bachelor's degree from an accredited college or university preferred.

Experience

Minimum four (4) years of claims management experience or an equivalent combination of education and experience required.

Skills & Knowledge

• Working knowledge of relevant regulations, offsets, deductions, disability duration, medical management practices, and Social Security and Medicare applications.
• Excellent oral and written communication skills, including presentation abilities.
• Proficient in PC applications, particularly Microsoft Office products.
• Strong analytical and interpretative skills.
• Effective organizational and interpersonal skills.
• Exceptional negotiation skills.
• Able to collaborate in a team environment.
• Committed to meeting or exceeding service expectations.

WORK ENVIRONMENT

When applicable, we will consider reasonable accommodations.

Mental: Clear thinking ability with sound judgment, problem-solving skills, discretion, and ability to manage stress and multiple priorities to meet deadlines.

Physical: Computer keyboarding and travel as required.

Auditory/Visual: Hearing, vision, and communication.

The information provided is intended to describe the general nature and level of work performed by colleagues in this position. It is not a comprehensive list of functions or duties, and management may change or add duties as needed.

In line with legal requirements, Sedgwick provides a competitive salary range for positions in jurisdictions with pay transparency. For this role, the starting pay range is $70,000-$79,000 annually. Our comprehensive benefits package includes medical, dental, vision, 401k with matching, PTO, disability and life insurance, employee assistance programs, flexible spending accounts, health savings accounts, and other optional benefits.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you find this position exciting but don't meet every qualification, we encourage you to apply anyway. Sedgwick is committed to building a diverse, equitable, and inclusive workforce, recognizing that unique combinations of skills and experiences can be valuable.