Claims Resolution Specialist

6 days ago


San Diego, California, United States Sedgwick Full time

About Us

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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.

Our organization is committed to doing the right thing – one where caring counts. With over 30,000 colleagues across 80 countries, we demonstrate our shared purpose and values every day.

Learn more about us at our official video channel.

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A Career at Sedgwick

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We are seeking a highly skilled Claims Resolution Specialist to join our team. As a Claims Resolution Specialist, you will be responsible for analyzing mid- and higher-level workers' compensation claims to determine benefits due; ensuring ongoing adjudication of claims within company standards and industry best practices; and identifying subrogation of claims and negotiating settlements.

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The Ideal Candidate

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You must have a strong analytical mind, excellent communication skills, and the ability to work independently. You should also have experience with claims management software and a 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.

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Benefits Package

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We offer a comprehensive benefits package, including:

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  • A competitive salary of $55,000 - $77,000 per year, depending on your level of experience and qualifications.">
  • A generous PTO policy, allowing you to take time off when you need it.">
  • A 401(k) matching program, helping you save for your future.">
  • A comprehensive health insurance package, covering medical, dental, and vision care.">
  • A disability and life insurance plan, providing peace of mind for you and your loved ones.">
  • A flexible spending account, allowing you to set aside money for healthcare expenses.">
  • A range of additional voluntary benefits, tailored to your individual needs.">
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Location

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This role is based in [insert location]. You may be required to travel occasionally, but this will be minimal.

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About the Job

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This is a full-time position, requiring a high level of dedication and commitment. You will be working closely with our clients, colleagues, and other stakeholders to ensure the smooth resolution of claims.

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Your Responsibilities

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  1. ">
  2. Analyze mid- and higher-level workers' compensation claims to determine benefits due.">
  3. Ensure ongoing adjudication of claims within company standards and industry best practices.">
  4. Identify subrogation of claims and negotiate settlements.">
  5. Develop and manage action plans to resolution, coordinate return-to-work efforts, and approve claim payments.">
  6. Communicate claim actions with claimants and clients.">
  7. Ensure claim files are properly documented and claims coding is correct.">
  8. Maintain professional client relationships.">
  9. Perform other duties as assigned.">
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What We Offer

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We are an equal opportunities employer and a drug-free workplace. We recognize that each person possesses a unique combination of skills, knowledge, and experience. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway.



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