Sedgwick is hiring a Claims Representative specializing in Workers Compensation to join our team. This remote role focuses on processing low-level claims to determine benefits due and ensure ongoing adjudication within company standards and industry best practices. You'll play a key part in identifying subrogation opportunities and negotiating settlements.
What You'll Do
- Process low-level workers compensation claims, determining compensability and benefits due on long-term indemnity claims.
- Monitor reserve accuracy and file necessary documentation with the state agency.
- Develop and coordinate action plans for low-level claims to achieve resolution, including return-to-work efforts.
- Approve and process assigned claims, determine benefits due, and administer action plans per the claim or client contract.
- Administer subrogation of claims and negotiate settlements.
- Communicate claim actions clearly 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.
- Maintain professional client relationships.
- Support the organization's quality program(s).
- Travel as required.
What We're Looking For
- Two (2) years of claims management experience.
- An equivalent combination of education and experience.
- Successful completion of Claims Representative training.
Nice to Have
- A Bachelor's degree from an accredited college or university.
Benefits & Compensation
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental, vision, and 401K on day one.
Work Mode
This is a fully remote position.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
