Claims Associate - Workers Compensation - Rancho Cordova, CA or Orange, CA (On-Site)

Sedgwick; Rancho Cordova (CA); On-site; USD 30,000 - 34,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentive

Career development

Comprehensive benefits

Job summary

Sedgwick is hiring a Claims Associate for Workers' Compensation in Rancho Cordova, CA or Orange, CA. This on-site role entails analyzing reported WC claims, adjudicating benefits, and supporting a growing client base across diverse industries.

The ideal candidate has at least 1 year of office experience; a high school diploma or GED is required. Sedgwick offers comprehensive benefits, a collaborative culture, and opportunities for professional growth.

Qualifications

• Education: High school diploma or GED.
• Experience: 1 year general office experience; claims industry preferred.
• Licenses: Licenses as required.

Responsibilities

• Adjusts medical-only and minor lost-time workers' comp claims under close supervision.
• Supports other representatives with larger or complex claims.
• Processes claims determining compensability and benefits; monitors reserves and files docs with state agencies.
• Communicates claim actions with claimant, client and medical contacts.
• Ensures claims are documented and coding is correct.
• May process routine payments and status reports for lifetime/defined period medical claims.
• Maintains professional client relationships.

Skills

Analytical thinking

Attention to detail

Communication

Organizational skills

Team player

Education

High school diploma or GED

Tools

Claims software

Job description

Claims Associate - Workers Compensation | Rancho Cordova, CA or Orange, CA (On-Site)

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

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.
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.
Enjoy flexibility and autonomy in your daily work, your location, and your career path.
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 :

To analyze reported lower level workers compensation claims to determine benefits due; 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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

QUALIFICATIONS

Education & Licensing

• High school diploma or GED; 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 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
• 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.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $22-25/hr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Ang