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Claims Representative Workers Compensation
IF YOU CARE, THERE'S A PLACE FOR YOU HERE
For a career path that is both challenging and rewarding, join
Sedgwick's talented team of 27,000 colleagues around the globe.
Sedgwick is a leading provider of technology-enabled risk, benefits
and integrated business solutions. Taking care of people is at the
heart of everything we do. Millions of people and organizations
count on Sedgwick each year to take care of their needs when they
face a major life event or something unexpected happens. Whether
they have a workplace injury, suffer property or financial loss or
damage from a natural or manmade disaster, are involved in an auto
or other type of accident, or need time away from work for the
birth of a child or another medical situation, we are here to
provide compassionate care and expert guidance. Our clients depend
on our talented colleagues to take care of their most valuable
assets-their employees, their customers and their property. At
Sedgwick, caring counts. Join our team of creative and caring
people of all backgrounds, and help us make a difference in the
lives of others.
For more than 50 years, Sedgwick has been helping employers
answer virtually every question there is about workers'
compensation. We have experience in nearly every type of industry
and region and provide the industry's broadest range of programs
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
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
- Develops and coordinates low level workers compensation claims'
action plans to resolution, return-to-work efforts, and approves
- Approves and processes assigned claims, determines benefits
due, and administers action plan pursuant to the claim or client
- Administers subrogation of claims and negotiates
- Communicates claim action with claimant and client.
- Ensures claim files are properly documented and claims coding
- 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
- Maintains professional client relationships.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travels as required.
Education & Licensing
Bachelor's degree from an accredited college or university
Two (2) years of claims management experience or equivalent
combination of education and experience or successful completion of
Claims Representative training required.
Skills & Knowledge
- Developing knowledge of regulations, offsets and deductions,
disability duration, medical management practices and Social
Security and Medicare application procedure as applicable to line
- Excellent oral and written communication, including
- 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 Service Expectations
When applicable and appropriate, consideration will be given to
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
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