Claims Associate

Sedgwick Claims Management Services Ltd; Bartlesville (OK); On-site; USD 36,000 - 48,000; Full time

Job summary

Sedgwick is seeking a Claims Associate in Bartlesville, OK to analyze reported workers' compensation claims and determine benefits due, ensuring ongoing adjudication within company standards.

You will adjust medical-only and minor lost-time claims under supervision, support colleagues with larger claims, document cases, and maintain professional client relationships while contributing to quality programs.

Qualifications

• One year of general office experience or equivalent.
• Claims industry experience preferred.
• High school diploma or GED required.
• Licenses as required.

Responsibilities

• Analyzes reported claims to determine benefits due.
• Adjusts medical-only and minor lost-time claims under close supervision.
• Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
• Processes workers compensation claims determining compensability and monitors reserve accuracy; files necessary documentation with state agency.
• Communicates claim action/processing with claimant, client and appropriate medical contact.
• Ensures claim files are properly documented and claims coding is correct.
• May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.
• Maintains professional client relationships.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

Skills

Communication

Microsoft Office

Analytical skills

Organizational skills

Interpersonal skills

Teamwork

Meeting deadlines

Education

High school diploma or GED

Tools

Microsoft Office

Job description

By joining Sedgwick, you'll be part of something truly meaningful. It’s 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, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Claims Associate

PRIMARY PURPOSE OF THE ROLE:

To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.

• Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.
• Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
• Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency.
• Communicates claim action/processing with claimant, client and appropriate medical contact.
• Ensures claim files are properly documented and claims coding is correct.
• May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.
• Maintains professional client relationships.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing:

• One (1) year of general office experience or equivalent combination of education and experience required.
• Claims industry experience preferred.
• High school diploma or GED required.
• Licenses as required.

Skills & Knowledge

• Excellent oral and written communication 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 Performance Competencies

Work environment requirements include –

• Physical: Computer keyboarding
• Auditory/visual: Hearing, vision and talking
• Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

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

Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.

The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com