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Claims Representative Workers Compensation Specialist

1 month ago

Rancho Cucamonga, California, United States Sedgwick Full time
About the Role

We are seeking a skilled Claims Representative Workers Compensation to join our team at Sedgwick. As a key member of our team, 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, and monitoring reserve accuracy.
  • 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.
  • May process low-level lifetime medical and/or defined period medical claims, including state and physician filings and decisions on appropriate treatments recommended by utilization review.
  • Maintain professional client relationships.
Requirements
  • 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 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.
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.

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.

We are committed to building a diverse, equitable, and inclusive workplace and 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.

Caring counts.