- 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.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travels as required.
- 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
-
Complex Property Claims Adjuster
2 days ago
Frontline Insurance Lake Mary, United StatesJob Description · Job DescriptionSalary: · Join our dynamic team of innovators, creators, and problem solvers At Frontline Insurance, we're on a mission to Make Things Better We believe in fostering a collaborative, inclusive, and growth-oriented work environment where every tea ...
-
Claims Adjuster
2 weeks ago
Sedgwick Orlando, United States Paid WorkTaking 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. It's an opportuni ...
-
Claims Adjuster I
3 weeks ago
AmTrust Financial Maitland, United States· Claims Adjuster I · Job Locations · US-FL-Maitland · Requisition ID · Category · Claims - Workers Compensation · Position Type · Regular Full-Time · Overview · The Workers' Compensation Adjuster I is responsible for prompt and efficient investigation, evaluation and settlement ...
-
AmTrust Financial Maitland, United States· Workers' Compensation Complex Claims Adjuster · Job Locations · US-FL-Maitland · Requisition ID · Category · Claims - Workers Compensation · Position Type · Regular Full-Time · Overview · AmTrust Financial Services, a fast growing commercial insurance company, is seeking a Com ...
-
Workers' Compensation Complex Claims Adjuster
2 weeks ago
AmTrust Financial Services, Inc. Maitland, Florida, United States PermanentOverview: · AmTrust Financial Services, a fast growing commercial insurance company, is seeking a Complex Workers' Compensation Claims Adjuster. The successful candidate will directly handle the most complex claims to including Workers Compensation related claims. The successful ...
-
Workers' Compensation Claim Adjuster
2 weeks ago
CCMSI Maitland, Florida, United States PermanentOverview: · At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, ...
-
Multi-line Claim Adjuster
3 weeks ago
CCMSI Maitland, United StatesOverview: · At **CCMSI**, **we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Com ...
-
Field Property Claims Adjuster-Orlando, FL
3 weeks ago
Farmers Insurance Group Orlando, United StatesWe are Farmers · We are more than just your favorite commercials. ?At Farmers, we strive to deliver peace of mind to our customers by providing protection and comprehensive advice and delivering in the moments of truth. That means having people who can help us meet changing cust ...
-
Commercial General Liability Claims Adjuster
1 month ago
TheBest Claims Solutions Orlando, United States OTHEROur client, an A rated insurance carrier, is looking to add a Commercial General Liability Claims Adjuster to their staff. This is a desk position involving litigated and non-litigated general liability claims.Required Qualifications:5+ years of claims handling experience · 3+ ye ...
-
Senior Workers Compensation Claims Adjuster
3 weeks ago
Arthur J Gallagher Risk Management Services, Inc Orlando, United States OTHERStep into the world of Gallagher Bassett, where risk management becomes a canvas of possibilities. Join our growing team of dedicated professionals who guide those in need to the best possible outcomes for their health and wellbeing. As a steward of trust, you'll be part of a res ...
-
Commercial General Liability Claims Adjuster
1 week ago
TheBest Claims Solutions Orlando, United States OTHEROur client, an A+ rated insurance carrier, is looking to add a Commercial General Liability Claims Adjuster to their staff. This is a desk position involving litigated files and will require an extensive coverage background. This is a fully remote position.Required Qualifications ...
-
Lead Workers Compensation Claims Adjuster
1 month ago
Arthur J Gallagher Risk Management Services, Inc Orlando, United States OTHERStep into the world of Gallagher Bassett, where risk management becomes a canvas of possibilities. Join our growing team of dedicated professionals who guide those in need to the best possible outcomes for their health and wellbeing. As a steward of trust, you'll be part of a res ...
-
Medical Coder
1 week ago
Moore Medical Group Lake Mary, United StatesObjective: Review coding, scrub claims to optimize reimbursement and ensure coding compliance before submitting to payors. · Skills needed include: · 1. Nextgen preferred (or similar E.H.R) · 2. Excel – pivot tables, analysis · 3. Power BI proficiency is a plus but not required · ...
-
Complex Claims Consulting Director
3 weeks ago
CNA Lake Mary, United States Full timeJOB DESCRIPTION · : Essential Duties & Responsibilities: · Performs a combination of duties in accordance with departmental guidelines: · Manages an inventory of the most complex and high exposure Lawyers Professional Liability Claims by following company protocols to manage an ...
-
Claims Specialist- Latent Bodily Injury
1 week ago
The Hartford Lake Mary, United States Full timeSpecialist Claims - CH07DE We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals – and to help others accomplish theirs, too. Join our team as ...
-
Reinsurance Accountant
2 weeks ago
Hylant Lake Mary, United StatesDescription · The Opportunity: · The Captive Reinsurance Accountant role is to provide crucial support in the evaluation and management of reinsurance contracts, claims, and relationships with reinsurers. This is a key role in ensuring compliance with company policies, efficien ...
-
Sr. Commercial Claims Examiner
2 days ago
Frontline Insurance Lake Mary, United StatesJob Description · Job DescriptionSalary: · Join our dynamic team of innovators, creators, and problem solvers At Frontline Insurance, we're on a mission to Make Things Better We believe in fostering a collaborative, inclusive, and growth-oriented work environment where every tea ...
-
Office Manager
1 week ago
Massey Services Lake Mary, United StatesBased in Orlando, Florida, Massey Services is one of the nation's largest and most respected service companies, with a history of providing quality service for more than three decades. Celebrating 38 consecutive years of profitable growth, Massey Services and its subsidiary organ ...
-
General Liability Adjuster
3 weeks ago
TheBest Claims Solutions Lake Mary, United States OTHEROur client is looking to add a temporary General Liability Claims Adjuster to their team. This position would be responsible for handling litigated and non-litigated general liability claims. This is a fully remote position.Required Qualifications:3+ years experience handling Gen ...
-
Risk Officer
2 weeks ago
City of Casselberry, FL Casselberry, United StatesSalary: $70, $87,680.00 Annually · Location : City of Casselberry, FL · Job Type: Full-time · Job Number: · Department: Administrative Services · Division: Human Resources · Opening Date: 02/29/2024 · General Description · The Risk Officer is responsible for the administra ...
Workers' Compensation Claims Adjuster - Lake Mary, United States - Sedgwick
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. It's an opportunity to do something meaningful, each and every day. It's 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 you're someone who cares, there's 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
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
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
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
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.