Claims Specialist

2 weeks ago


Ontario, California, United States Sedgwick Full time

Join Our Team as a Claims Specialist

At Sedgwick, we prioritize the well-being of our colleagues, ensuring a supportive and nurturing work environment. A career with us means embracing a culture of care, where flexibility and personal priorities are valued. It’s an opportunity to engage in meaningful work that makes a difference every day while receiving support for your mental, physical, financial, and professional needs. Here, you can enhance your skills and advance your career in a diverse and inclusive setting.

About Sedgwick
We are committed to making a positive impact on the world through our services to individuals and organizations. If you are passionate about making a difference and thrive on challenges, we welcome you to be part of our mission.

Position Overview

PRIMARY PURPOSE: To evaluate reported lower-level workers' compensation claims to ascertain the benefits owed and ensure ongoing claim management aligns with company standards and industry best practices.

KEY RESPONSIBILITIES:

  • Manage medical-only claims and minor lost-time workers' compensation claims under close supervision.
  • Assist other claims representatives and examiners with more complex claims as needed.
  • Process workers' compensation claims, determining compensability and benefits due; ensure reserve accuracy and file necessary documentation.
  • Communicate claim actions and processing updates with claimants, clients, and relevant medical contacts.
  • Ensure proper documentation and coding of claim files.
  • May handle routine payments and status reports for medical claims.
  • Maintain professional relationships with clients.
ADDITIONAL RESPONSIBILITIES:
  • Perform other assigned duties.
  • Support the organization's quality initiatives.
QUALIFICATIONS

Education & Licensing
A high school diploma or GED is required. Relevant licenses as necessary.

Experience
One (1) year of general office experience or a combination of education and experience is required. Experience in the claims industry is preferred.

Skills & Knowledge:
  • Strong oral and written communication abilities.
  • Proficient in PC applications, including Microsoft Office.
  • Analytical and interpretive skills.
  • Excellent organizational capabilities.
  • Interpersonal skills to foster teamwork.
  • Ability to meet or exceed performance standards.
WORK ENVIRONMENT
We consider reasonable accommodations when applicable.

Mental: Clear thinking, excellent judgment, problem-solving, and discretion; ability to manage work-related stress and multiple priorities.

Physical: Computer keyboarding and occasional travel as required.

Auditory/Visual: Hearing, vision, and verbal communication.

NOTE: A background credit check is required for this position.

At Sedgwick, we are an Equal Opportunity Employer and maintain a Drug-Free Workplace. We encourage individuals with diverse backgrounds to apply, recognizing that each person brings a unique set of skills and experiences that contribute to our success.

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