Claims Associate - Workers Compensation

Sedgwick; Negaunee Township (MI); On-site; USD 42,000 - 65,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentives

Career growth

Job summary

Sedgwick is seeking a Claims Associate to analyze and adjudicate medical-only workers compensation claims at our Negaunee, MI location. You will help determine benefits due, support complex claims, and maintain accurate documentation while upholding company standards.

The ideal candidate has a high school diploma or GED and at least one year of general office experience; claims industry experience is preferred. Sedgwick offers a caring culture and growth opportunities.

Qualifications

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

Responsibilities

• Adjust medical-only claims and minor lost-time workers compensation claims under close supervision.
• Support other claims representatives, examiners and leads with larger or more complex claims.
• Process workers compensation claims determining compensability and benefits due; monitor reserve accuracy and file documentation with state agency.
• Communicate claim actions with claimants, clients, and medical contacts.
• Ensure claim files are properly documented and claims coding is correct.
• May process routine payments and prescriptions and status reports for lifetime/defined period medical claims.
• Maintain professional client relationships.

Skills

General office experience

Claims experience

Education

High school diploma or GED

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 - Workers Compensation

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?

• 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 world’s most respected organizations.
• Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.

ARE YOU AN IDEAL CANDIDATE?

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

OFFICE LOCATION:

205 Iron Street Negaunee, MI 49866

PRIMARY PURPOSE:

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

ESSENTIAL FUNCTIONS And RESPONSIBILITIES

• 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.

Qualifications

• High school diploma or GED required. Licenses as required.
• One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience 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, 401K on day one.

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.

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! 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.