Job Description

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Claims AdjusterIF YOU CARE, THERES A PLACE FOR YOU HERE

For a career path that is both challenging and rewarding, join Sedgwicks talented team of 27,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assetstheir employees, their customers and their property. At Sedgwick, caring counts. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.

For more than 50 years, Sedgwick has been helping employers answer virtually every question there is about workers compensation. We have experience in nearly every type of industry and region and provide the industrys broadest range of programs and services.

**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.

locationCharleston, WVlocationCharleston, WVlocationCharleston, WV

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