Claims Representative Workers Compensation Specialist
4 days ago
Sedgwick is seeking a skilled Claims Representative to join our team. As a Claims Representative, you will be responsible for processing low-level workers' compensation claims, determining benefits due, and ensuring ongoing adjudication of claims within company standards and industry best practices.
Key Responsibilities:- Process low-level workers' compensation claims, determining compensability and benefits due on long-term indemnity claims, monitoring reserve accuracy, and filing necessary documentation with state agencies.
- Develop and coordinate low-level workers' compensation claims' action plans to resolution, return-to-work efforts, and approve claim payments.
- Administer subrogation of claims and negotiate settlements.
- Communicate claim action with claimants and clients.
- Ensure claim files are properly documented and claims coding is correct.
- Bachelor's degree from an accredited college or university preferred.
- Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.
- Developing knowledge of regulations, offsets, and deductions, disability duration, medical management practices, and Social Security and Medicare application procedure as applicable to the line of business.
- Excellent oral and written communication, including presentation 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 Service Expectations.
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.
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Ontario, California, United States Sedgwick Full timeAbout the RoleWe are seeking a skilled Claims Representative to join our team at Sedgwick. As a Claims Representative, you will play a critical role in processing low-level workers' compensation claims, ensuring timely and accurate benefits are provided to our clients.Key ResponsibilitiesProcess low-level workers' compensation claims, determining...
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Ontario, California, United States Sedgwick Full timeAbout the RoleWe are seeking a skilled Claims Representative Workers Compensation to join our team at Sedgwick. As a key member of our organization, you will play a vital role in processing low-level workers compensation claims, determining benefits due, and ensuring ongoing adjudication within company standards and industry best practices.Key...
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