Current jobs related to Claims Adjuster - Ontario - Sedgwick

  • Workers' Compensation Claims Adjuster

    1 month ago

    Ontario, California, United States AdminSure Inc Full time

    Job SummaryWe are seeking a highly skilled Workers' Compensation Claims Adjuster to join our team at AdminSure Inc. in Ontario, California. As a Senior WC Adjuster, you will be responsible for managing a caseload of approximately 125 claims, with a focus on diary management, high-level service, and proactive claim resolution/closure skills.Key...

  • Manager, Corporate Payroll

    2 months ago

    Ontario, United States Ajinomoto Foods North America Full time

    Overview The Payroll Manager is integral in optimizing payroll processes, ensuring compliance, and fostering a culture of development and governance. As a forward-thinking leader, the Payroll Manager will be pivotal in shaping the payroll function to not only meet current demands but also anticipate future needs and challenges. This role, you will not only...

  • Healthcare Operations Manager

    2 weeks ago

    Ontario, California, United States UnitedHealth Group Full time

    IPA Operations Manager Job DescriptionAt UnitedHealth Group, we're committed to helping people live healthier lives and making the health system work better for everyone. As an IPA Operations Manager, you'll play a critical role in achieving this mission.Key Responsibilities:Provider Relations: Develop and maintain strong relationships with network providers...

  • Vocational Rehabilitation Specialist

    3 days ago

    Ontario, California, United States Paradigm Full time

    Job Summary: We are seeking a skilled Vocational Rehabilitation Specialist to join our team at Paradigm. As a Vocational Rehabilitation Specialist, you will play a critical role in helping individuals with complex and catastrophic injuries or diagnoses return to work. Your expertise will be instrumental in providing a full range of vocational rehabilitation...

  • Service Manager

    4 weeks ago

    Ontario, United States Kenworth Sales Full time

    Kenworth Sales Company is hiring for a Service Manager in our Ontario, Oregon location. This a great opportunity with a reputable company with and room for advancement. We offer a full benefits package including 401k and Roth.  Are you looking for an opportunity to join an industry leader with a strong foundation of success? Kenworth Sales Company was...

  • Insurance Sales Professional

    1 week ago

    Ontario, California, United States Aims Insurance Services, Inc Full time

    Job DescriptionAims Insurance Services, Inc is a leading insurance services provider committed to excellence. Our team is dedicated to delivering top-notch service to our valued clients.As an Insurance Sales Representative, you will have the opportunity to connect with clients, understand their insurance needs, and provide them with tailored solutions that...

  • IPA Operations Manager

    7 days ago

    Ontario, California, United States UnitedHealth Group Full time

    Unlock Your Potential as an IPA Operations ManagerAre you passionate about shaping the future of healthcare? Do you thrive in fast-paced environments where no two days are the same? We're seeking a highly motivated and organized IPA Operations Manager to join our team at UnitedHealth Group.Key Responsibilities:Develop and maintain strong relationships with...

  • Vocational Rehabilitation Specialist

    3 days ago

    Ontario, CA, United States Paradigm Full time

    At Paradigm, we're dedicated to helping individuals with complex and catastrophic injuries and diagnoses return to work. As a Vocational Case Manager, you'll play a vital role in this process.Key Responsibilities:Schedule appointments and meet with clients, family members, insurance adjusters, medical providers, employers, attorneys, vendors, and potential...

  • Distribution Center Customer Service Associate

    5 months ago

    Ontario, United States Genuine Parts Company Full time

    Job Description Job holder is responsible for performing any other duties as assigned by management. List the significant activities that support that function, for instance manage the annual store audit process. Where possible use language that ties the job back to the company mission and vision. Responsibilities Reviews and corrects coding for...

  • Vocational Rehabilitation Specialist

    3 days ago

    Ontario, CA, United States Paradigm Full time

    At Paradigm, we are dedicated to improving the lives of individuals with complex and catastrophic injuries and diagnoses. Our team of vocational case managers provides a full range of vocational rehabilitation services to assist individuals in returning to employment. We are seeking a skilled and compassionate Vocational Case Manager to join our team in the...

Claims Adjuster

4 months ago

Ontario, United States Sedgwick Full time

**Claims Adjuster - Workers Compensation**

**Claims Adjuster - Workers Compensation**

**The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.**

Claims Adjuster - Workers CompensationIF YOU CARE, THERES A PLACE FOR YOU HERE

For a career path that is both challenging and rewarding, join Sedgwicks 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 assetstheir 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 industrys broadest range of programs and services.

**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**

* 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.

**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**

Four (4) years of claims management experience or equivalent combination of education and experience required.

**Skills & Knowledge**

* 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

**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.

location4 Locationslocation4 Locations