• Investigate and evaluate Florida workers’ compensation claims to determine compensability, exposure, and total claim value in accordance with Florida statutes and case law. • Establish and maintain appropriate reserves using reserving tools, ODG guidelines, and company reserving philosophy. • Initiate and manage indemnity payments and maintain diary systems for ongoing payments and claim activity. • Complete state-required filings and EDI reporting accurately and within required timelines. • Assign and coordinate with defense counsel on litigated claims and assist with litigation strategy. • Collaborate with Nurse Case Managers to monitor medical treatment and authorize appropriate medical services under Florida Statute 440.13. • Review and approve medical bills within required timeframes. • Determine need for vocational rehabilitation services to assist injured employees with return-to-work planning. • Coordinate light duty opportunities and workplace accommodations with employers and medical providers. • Maintain consistent communication with clients and attend client meetings as required. • Maintain accurate documentation, diaries, and workflow management to ensure regulatory compliance. • Identify potential subrogation or recovery opportunities and pursue appropriate reimbursement from responsible parties. • Protect Medicare’s interests and ensure compliance with MMSEA Section 111 reporting requirements. • Monitor claims for red flags or potential fraud indicators. • Request reimbursement from excess carriers as required and follow up on outstanding recoveries. • Escalate client concerns or E&O risks to leadership when appropriate. • Maintain performance expectations, including a 97% claim closure ratio.

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 Specialty Operations Coordinator PRIMARY PURPOSE: To analyze low- and mid-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. ESSENTIAL FUNCTIONS and RESPONSIBILITIES - Adjusts medical-only claims and low- to mid-level lost-time workers compensation claims under close supervision. - Supports other claims staff with larger or more complex claims as necessary. - Processes workers compensation claims reviewing compensability, benefits due, and files necessary documentation with state agency. - Communicates claim action/processing with appropriate parties including, but not limited to: claimant, client, state agency, managed care organization and appropriate medical contact. - Ensures claims files are properly documented and claims coding is correct. - Maintains professional client relationships. - Coordinates actuarial/settlement issues impacting employers with rate and settlement departments. QUALIFICATIONS Education & Licensing High School diploma or GED required. Licenses as required. Experience One (1) year of claims management experience or equivalent combination of education and experience required. Skills & Knowledge - Excellent oral and written communication skills - PC literate, including Microsoft Office products - Analytical and interpretive skills - Strong organizational skills - Good interpersonal skills - Ability to work in a team environment - Ability to meet or exceed Performance Competencies. - Supports the organization's quality program(s). - Performs other duties as assigned. WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. TAKING CARE OF YOU BY - We offer a diverse and comprehensive benefits package including: - Three Medical, and two dental plans to choose from. - Tuition reimbursement eligible. - 401K plan that matches 50% on every $ you put in up to the first 6% you save. - 4 weeks PTO your first full year. NEXT STEPS If your application is selected to advance to the next round, a recruiter will be in touch. 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 $16.00 - 20.00/hr. 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. 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.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description We’re currently seeking an experienced Workers’ Compensation Legal Adjuster to join our growing team. In this role, you’ll manage Florida workers’ compensation claims, including litigated files, while ensuring compliance with Florida statutes and delivering exceptional service to our clients. This position will investigate and manage Florida workers’ compensation claims from assignment through resolution. You’ll evaluate claim details, apply Florida statutes and case law to determine compensability, and establish appropriate reserves while ensuring timely payments and regulatory compliance. You’ll collaborate with defense counsel, nurse case managers, and clients while managing litigation strategy and maintaining a proactive approach to claim resolution. Key Responsibilities - Investigate and evaluate Florida workers’ compensation claims to determine compensability, exposure, and total claim value in accordance with Florida statutes and case law. - Establish and maintain appropriate reserves using reserving tools, ODG guidelines, and company reserving philosophy. - Initiate and manage indemnity payments and maintain diary systems for ongoing payments and claim activity. - Complete state-required filings and EDI reporting accurately and within required timelines. - Assign and coordinate with defense counsel on litigated claims and assist with litigation strategy. - Collaborate with Nurse Case Managers to monitor medical treatment and authorize appropriate medical services under Florida Statute 440.13. - Review and approve medical bills within required timeframes. - Determine need for vocational rehabilitation services to assist injured employees with return-to-work planning. - Coordinate light duty opportunities and workplace accommodations with employers and medical providers. - Maintain consistent communication with clients and attend client meetings as required. - Maintain accurate documentation, diaries, and workflow management to ensure regulatory compliance. - Identify potential subrogation or recovery opportunities and pursue appropriate reimbursement from responsible parties. - Protect Medicare’s interests and ensure compliance with MMSEA Section 111 reporting requirements. - Monitor claims for red flags or potential fraud indicators. - Request reimbursement from excess carriers as required and follow up on outstanding recoveries. - Escalate client concerns or E&O risks to leadership when appropriate. - Maintain performance expectations, including a 97% claim closure ratio. Qualifications - Workers’ compensation claims handling experience, including lost time and litigated claims. - Active Florida All-Lines Adjuster License or Florida Workers’ Compensation License. - Experience evaluating claims, setting reserves, and managing litigation files. - Strong knowledge of Florida Workers’ Compensation statutes and rules. - Experience coordinating with defense counsel and nurse case managers. - Proficiency with Microsoft Office Suite. - Excellent written and verbal communication skills. - Strong organization, prioritization, and time-management skills in a fast-paced environment. - Ability to work independently while collaborating with a team. - Experience handling multiple claim types or presumption claims. - Experience with depositions, mediations, and settlement negotiations. - Familiarity with systems such as IDatix, Workers Computation, ISO, or ShoreTel. Benefits - Medical, dental, and vision plans to ensure your health and that of your family. - A 401k plan with employer matching to help you build a secure financial future. - Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) package for non-exempt employees. - Paid holidays. - Life insurance and both short-term and long-term disability plans.

Job DetailsJob Location: Fargo , ND 58102Salary Range: $52,000.00 - $65,000.00 SalarySummary: Nodak Insurance is seeking a highly motivated Material Damage Desk Appraiser. This position is responsible for evaluating, negotiating, and resolving material damage insurance claims involving physical damage to vehicles across multiple states. The role is based in our Fargo office; however, remote applicants residing in or near Sioux Falls, SD may also be considered. Essential Duties and Responsibilities: Conduct virtual estimates and supplements using customer‑ or repair‑shop‑provided photos for claims primarily in North Dakota, South Dakota, Nebraska, and Illinois. Review and revise auto body shop estimates in CCC One for collision and other material damage losses to ensure alignment with Nodak Insurance Company guidelines. Collaborate with field staff and Nodak’s Direct Repair Shop network to obtain photos and information necessary to accurately evaluate vehicle damage. Negotiate with auto repair facilities to reach agreement on the final cost of repairs. Determine the Actual Cash Value (ACV) for vehicles deemed total losses and coordinate with the total loss team to facilitate handling. Travel occasionally, as needed, to storm‑impacted areas to assist with high‑volume claims on site. Identify and report potential external fraud indicators or underwriting concerns. QualificationsEducation and Experience: Proficiency with CCC One estimating software and a strong understanding of automobile repair processes. An associate or bachelor’s degree is preferred; however, equivalent experience or prior work in an auto body repair facility will be considered. Professional designations such as AIC (Associate in Claims) or AINS (Associate in General Insurance) are a plus. Required Knowledge and Skills: Strong negotiation skills, exceptional attention to detail, and the ability to manage a high volume of claims efficiently. Ability to collaborate effectively with a wide range of adjusters; a team‑oriented mindset is essential. A strong interest in automobiles (cars, trucks, or anything with a motor) and a comfort level using advanced technology to solve problems and support customers. This role is an excellent fit for individuals who enjoy combining technical knowledge with customer service. Physical Requirements: Able to work in a typical office setting where the employee may occasionally lift and/or move up to 10 pounds. The noise level in the work environment is usually moderate. Occasional travel required (< 10%) Nodak Insurance Company complies fully with all federal, state, and local employment laws and shall provide equal employment and advancement opportunities for all persons regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, the presence of any mental or physical disability, status with regard to public assistance or marriage, or any other category protected by local, state or federal law.