Claims Representative

Claims Representative Workers Compensation

Join to apply for the Claims Representative Workers Compensation | Jurisdiction: Multi State | TX/FL/OK/LA License preferred (Remote/Hybrid) role at Sedgwick.

By joining Sedgwick, you'll be part of something truly meaningful. Its what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work?life balance. Here, theres no limit to what you can achieve.

Newsweek Recognizes Sedgwick as Americas Greatest Workplace, National Top Companies. Certified as a Great Place to Work. Fortune Best Workplaces in Financial Services & Insurance.

What Youll Experience

• Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
• Deliver innovative customer?facing solutions to clients who represent virtually every industry and comprise some of the worlds most respected organizations.
• Be a part of a rapidly growing, industry?leading global company known for its excellence and customer service.
• Leverage Sedgwicks broad, global network of experts to both learn from and to share your insights.
• Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
• Enjoy flexibility and autonomy in your daily work, your location, and your career path.
• Access diverse and comprehensive benefits to take care of your mental, physical, financial, and professional needs.
  

Core Responsibilities

• Process low?level workers compensation claims determining compensability and benefits due on long?term indemnity claims, monitor reserve accuracy, and file necessary documentation with state agency.
• Develop and coordinate low?level workers compensation claims action plans to resolution, return?to?work efforts, and approve claim payments.
• Approve and process assigned claims, determine benefits due, and administer action plan pursuant to the claim or client contract.
• Administer subrogation of claims and negotiate settlements.
  
• Communicate claim action with claimant and client.
• Ensure claim files are properly documented and claim coding is correct.
• May process low?level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintain professional client relationships.
• Perform other duties as assigned.
• Support the organizations quality program(s).
• Travel as required.
  

Office Location

This position follows a hybrid work model for candidates residing within a 25?mile radius of a Sedgwick office. Employees in this range will be expected to commute to the office on a hybrid schedule. Candidates located outside of this radius will be considered for a fully remote arrangement.

Primary Purpose of the Role

We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

Qualifications

• Bachelors 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.
• Jurisdiction: Multi State 15 states.
• Licensing: Required TX/FL/OK/LA preferred.
  

Taking Care of You

• Flexible work schedule.
• Referral incentive program.
• Career development and promotional growth opportunities.
• A diverse and comprehensive benefits offering including medical, dental, vision, 401(k) on day one.
  

Sedgwick is an Equal Opportunity Employer and a Drug?Free Workplace.

If youre excited about this role but your experience doesnt align perfectly with every qualification in the job description, consider applying for it anyway Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

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