Claims Associate - Workers Compensation

Sedgwick Claims Management Services Ltd; Negaunee Township (MI); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401K on day one

Flexible work schedule

Job summary

Sedgwick is seeking a Claims Associate - Workers Compensation to analyze reported medical-only claims and adjudicate benefits under company standards. The role emphasizes accurate processing and professional client communication.

Based in a collaborative environment, the candidate will support complex claims, maintain detailed documentation, and contribute to timely resolution across our Michigan operations.

Qualifications

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

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.

Skills

Claims processing

Customer service

Communication

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

• Education & Licensing: High school diploma or GED required. Licenses as required.
• Experience: 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.

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.

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 the world\’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. 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