Claims Associate - Workers Compensation

Sedgwick Claims Management Services Ltd; Raleigh (NC); Hybrid; USD 42,000 - 56,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development and promotional增长

Job summary

Sedgwick is hiring a Claims Associate - Workers' Compensation to analyze and adjudicate lower-level claims and support more complex cases as needed. This telecommuter-friendly role in Raleigh, NC offers a path for professional growth and involvement in a broad client base.

You will assess compensability, document claims, and maintain strong client relationships, with a focus on accuracy and timely processing in a collaborative environment.

Qualifications

• Education & Licensing: High School Diploma or GED required.
• Bachelor’s degree from an accredited college or university preferred.
• Professional certification as applicable to line of business preferred.
• Experience: 1 year of claims management experience or equivalent combination of education and experience required.

Responsibilities

• Analyze reported workers' compensation claims to determine benefits due and adjudicate claims.
• Assist other claims representatives and leads with larger or more complex claims as needed.
• Process claims determining compensability and benefits due; monitor reserve accuracy and file documentation with state agencies.
• Communicate claim actions with claimants, clients and medical contacts.
• Ensure claim files are correctly documented and claims coding is accurate.

Skills

Claims management

Education

High School Diploma or GED

Bachelor’s degree

Job description

## Claims Associate - Workers CompensationApply: Telecommuter NC: Raleigh, NC: Full time: Posted Today: R79347By 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 CompaniesCertified as a Great Place to WorkFortune Best Workplaces in Financial Services & InsuranceClaims Associate - Workers CompensationAre 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? * 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.* Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.* Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. .* Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. **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. **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. **ESSENTIAL RESPONSIBLITIES MAY INCLUDE*** 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. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Experience: 1 years of claims management experience or equivalent combination of education and experience required. **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 REQUIREMENTS** **INCLUDE** 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 requiredAuditory/Visual: Hearing, vision and talking #claimsexaminer #claims #hybrid #LI-REMOTE 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.