Claims Representative

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

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Claims Representative - Workers Compensation
- PRIMARY PURPOSE: To process low level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements with general supervision.
- ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
- Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.
- Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
- Administers subrogation of claims and negotiates settlements.
- Communicates claim action with claimant and client.
- Ensures claim files are properly documented and claims 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.
- Maintains professional client relationships.
- ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travels as required.
- QUALIFICATIONS
- Education & Licensing
- Bachelor's degree from an accredited college or university preferred.
- Experience
- Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.
- Skills & Knowledge
- 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
- NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
- 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.
- As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in CO, NY, WA, or CA. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the state noted in this job posting only, the range of starting pay for this role is 39K -65K. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

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