Claims Associate - Workers Compensation & Med Only | Jurisdiction: NC |Licensing: Required (Remote)

Sedgwick; North Carolina; Remote; USD 42,000 - 64,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401K on day one

Career development

Job summary

Sedgwick in the United States is seeking a Claims Associate - Workers Compensation to analyze reported claims and determine benefits due, ensuring adjudication aligns with company standards.

You will adjust medical-only and minor lost-time claims under supervision, support more complex cases, and communicate actions with claimants and clients; a Bachelor's degree is preferred and 1 year claims experience is required.

Qualifications

• 1 year of claims management experience or equivalent combination of education and experience.
• Bachelor's degree preferred in a related field.
• Strong attention to detail and communication skills.

Responsibilities

• Adjusts medical-only claims and minor lost-time workers' comp claims under close supervision.
• Processes workers' compensation claims and communicates actions to claimants and clients.
• Ensures claims are properly documented and coded.
• Supports other claims representatives on larger or more complex claims.

Skills

Claims management

Attention to detail

Communication skills

Education

High School Diploma or GED

Bachelor's degree preferred

Job description

Fortune Best Workplaces in Financial Services & Insurance

Claims Associate - Workers Compensation

• 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.

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.

• 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; 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.

Education & Licensing: High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Experience: 1 years of claims management experience or equivalent combination of education and experience required.

Flexible work schedule.

Career development and promotional growth opportunities.

• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

excellent judgment, troubleshooting, problem solving, analysis, and discretion; Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

#claimsexaminer #claims #hybrid #LI-REMOTE

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