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Claims Processing Specialist
2 months ago
Join Our Team as a Claims Processing Specialist
At Sedgwick, we prioritize the well-being of our colleagues, fostering a culture that emphasizes care and support. We believe in providing flexibility and the opportunity to focus on what truly matters in your life. Here, you can engage in meaningful work every day while receiving the necessary support for your mental, physical, financial, and professional growth. Our inclusive environment celebrates diversity and encourages career advancement.
Why Choose Sedgwick?
Being part of Sedgwick means aligning your passion with purpose, positively impacting the lives of individuals and organizations we serve. If you are motivated to make a difference, embrace challenges, and genuinely care about others, you will find a fulfilling career with us.
Recognitions:
Great Place to Work
Most Loved Workplace
Forbes Best-in-State Employer
PRIMARY PURPOSE: To manage low-level general liability claims, ensuring accurate determination of benefits and compliance with company standards and industry best practices. This role involves identifying subrogation opportunities and negotiating settlements under general supervision.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
- Process low-level general liability claims by collecting necessary information to assess liability exposure; assign reserve values and authorize claim payments as needed.
- Develop and implement action plans for low-level general liability claims, including return-to-work strategies and payment approvals.
- Administer claims by determining benefits due and executing action plans according to client contracts.
- Oversee subrogation processes and negotiate settlements effectively.
- Maintain clear communication regarding claim actions with claimants and clients.
- Ensure proper documentation of claim files and accurate claims coding.
- May handle low-level lifetime medical and defined period medical claims, including state and physician filings.
- Foster professional relationships with clients.
ADDITIONAL FUNCTIONS AND RESPONSIBILITIES:
- Perform other assigned duties.
- Support the organization's quality initiatives.
- Travel as necessary.
QUALIFICATIONS:
Education & Licensing:
A bachelor's degree from an accredited institution is preferred.
Experience:
A minimum of two years in claims management or a combination of education and experience, or successful completion of Claims Representative training is required.
Skills & Knowledge:
- Understanding of regulations, offsets, deductions, disability duration, and medical management practices.
- Excellent oral and written communication skills, including presentation abilities.
- Proficient in PC applications, particularly Microsoft Office.
- Strong analytical and interpretive skills.
- Exceptional organizational capabilities.
- Good interpersonal skills and the ability to work collaboratively.
- Ability to meet or exceed service expectations.
WORK ENVIRONMENT:
Reasonable accommodations will be considered when applicable.
Mental: Requires clear thinking, excellent judgment, problem-solving skills, and the ability to manage work-related stress and multiple priorities.
Physical: Involves computer keyboarding and occasional travel.
Auditory/Visual: Requires hearing, vision, and verbal communication.
NOTE: A credit security clearance, confirmed through a background credit check, is necessary for this position.
At Sedgwick, we are committed to equal opportunity and maintaining a drug-free workplace.
If you are interested in this role but your experience does not align perfectly with every qualification, we encourage you to apply anyway. Sedgwick values diversity and recognizes that each individual brings a unique set of skills and experiences.
