索赔调整员 - 工伤保险 | 管辖范围：TX, MN, MI | 许可证：
Claims Adjuster - Workers Compensation | Jurisdiction: TX, MN, MI | Licensing:
加入Sedgwick，你将参与真正有意义的事业。我们的33,000名同事每天为全球面临意外的人们提供帮助。我们邀请你与我们共同成长，体验我们的关怀文化，并享受工作与生活的平衡。在这里，你的成就没有上限。
Newsweek 将 Sedgwick 评为美国最佳职场全国顶级公司之一
被认证为最佳工作场所®
财富最佳金融与保险行业工作场所
理赔专员 - 工伤赔偿 | 所属地区：TX、MN、MI | 资质要求：需持有 TX 或常住州执照 - 远程办公
你是否正在寻找一个机会，加入一家全球行业领导者，用你的创意帮助解决一些世界顶级品牌的难题？
- 在充满活力的文化背景下，运用你的知识和经验处理复杂的客户索赔。
你是否是理想的候选人？我们寻找那些体现我们关怀文化模型及核心价值观的人，包括同理心、责任感、协作、成长和包容。
职位主要职责：分析中高风险工伤赔偿索赔，确定应得福利；确保在公司标准和行业最佳实践范围内持续处理索赔；识别索赔追偿并协商和解。
关键职责可能包括
- 管理工伤赔偿索赔，确定长期赔偿金的可赔付性及应得福利，监控准备金准确性，并向州机构提交必要文件。
- 制定并管理工伤赔偿索赔的行动计划以达成解决，协调重返工作岗位的工作，并批准索赔付款。
- 审批并处理分配的索赔，确定应得福利，并根据索赔或客户合同管理行动计划。
- 管理索赔追偿并协商和解。
- 与索赔人和客户沟通索赔进展。
- 确保索赔文件完整记录，索赔编码正确。
- 可能处理复杂的终身医疗和/或特定期间医疗索赔，包括州和医生的文件及对利用审查推荐的适当治疗的决定。
- 维护专业的客户关系。
资格要求
教育与资质：优先考虑来自认可大学或学院的学士学位。根据业务线，优先考虑相关专业认证。
查看英文原文
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.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Claims Adjuster - Workers Compensation | Jurisdiction: TX, MN, MI | Licensing: TX or Home State required - RemoteAre 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.
ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
PRIMARY PURPOSE OF THE ROLE: 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 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.
QUALIFICATIONS
Education and Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
Experience
Four (4) years of claims management experience or equivalent combination of education and experience required.
Jurisdiction Knowledge: TX, MN, MI
Licensing: TX
TAKING CARE OF YOU
- Flexible work schedule.
- Referral incentive program.
- Opportunity to work in an agile environment.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
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
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.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($60,000.00-$85,000.00. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
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.
Originally posted on Himalayas