Claims Associate-Medical Risk

1 week ago


Toledo, United States Sedgwick Full time

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. It's having support for your mental, physical, financial and professional needs. And it means working in an environment that celebrates diversity and is fair and inclusive.

PRIMARY PURPOSE** : To provide initial research/data collection on new workers compensation (WC) claims; to assist in prompt and accurate reporting of required and situational claim data elements to the Bureau of Workers Compensation (BWC) via electronic data transmission; and to receive, review and research new claim EDI transmission from BWC.

**Receives notices of new claims via telephone, BWC-EDA-148 transmissions, or first report of injury (FROI) through FROI form, C-9, and other documentation; and receives, reviews and researches FROI reports to obtain required and situational data elements to facilitate initial EDI to BWC.

+ Receives, reviews and researches new EDI transmissions from BWC to identify case acuity level and refers to disability management per CHS policy; initiates first EDI on new claim within four (4) calendar days.

+ Communicates with service provider, injured worker and employer to obtain accurate data elements for evaluation and identification of acuity level.

+ Identifies appropriate staff to facilitate prompt assignment of new claims.

+ communicates this to assigned staff.

+ Educates employers to expedite early communications for FROI and RTW Services through CHS medical case management process.

+ Maintains current knowledge of BWC rules/laws, WC process and CHS policies and procedures.

**Supports the organization's quality programs.

**One (1) year of general office experience or equivalent combination of education and experience required. PC literate, including Microsoft Office products

+ Ability to provide confirmation for identification of the Degree of Disability Management (DoDM)

+ Ability to meet or exceed Performance Competencies

**excellent judgment, troubleshooting, problem solving, analysis, and discretion; 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. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Watch this video to learn more about us. (



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