Claims Representative - Workers Compensation (REMOTE - MI, MN, TX, UT, CO, IL, IN WI & KY exp)
- 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? 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: To process low 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 with general supervision.
- ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Processes low level 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 coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.
- Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
- Administers 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 low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
- 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:
Two (2) years of Workers Compensation claims management experience or equivalent combination of education and experience required.
- 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.
Apply Job!
Apply to this Job