By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

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Claims Adjuster - Workers Compensation | Hybrid Omaha, ID or Des Moines,IA | TX, FL, or NY Licensing

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands? 

• Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. 
• Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.
• Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. 
• Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights. 
• Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. 
• Enjoy flexibility and autonomy in your daily work, your location, and your career path. 
• Access diverse and comprehensive benefits to take care of your mental, physical, financial, and professional needs. 

ARE YOU AN IDEAL CANDIDATE? 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.

OFFICE LOCATION: Hybrid 2 days in office in Omaha, ID or De Monies, IA.

PRIMARY PURPOSE OF THE ROLE: We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• 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.

Jurisdiction Knowledge: Midwest states, GA, KY, CO,AZ, UT.

Licensing: TX, FL or NY that can reciprocate to other states preferred.

TAKING CARE OF YOU

Flexible work schedule. 

Referral incentive program. 

Career development and promotional growth opportunities. 

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

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.