Claims Representative - Workers Compensation (Remote - Med Only or Minor Lost Time Claims Exper[...]

Sedgwick; North Carolina; Remote; USD 50,000 - 70,000; Full time

Job summary

Sedgwick, a leading company in insurance, is seeking a Claims Representative for remote work in North Carolina. The role involves processing low level workers' compensation claims, ensuring compliance with standards, and communicating with clients. Ideal candidates should have strong organizational skills, analytical abilities, and a Bachelor's degree. Entry-level opportunities available, providing a chance to grow within a supportive culture.

Qualifications

• Two (2) years of claims management experience or equivalent.
• Developing knowledge of disability duration and medical management practices.
• Ability to meet or exceed service expectations.

Responsibilities

• Process low level workers compensation claims.
• Develop and coordinate action plans for resolution.
• Communicate claim actions with clients and ensure proper documentation.

Skills

Excellent oral and written communication

Analytical and interpretive skills

Strong organizational skills

Ability to work in a team environment

Education

Bachelor's degree from an accredited college or university

Job description

Claims Representative - Workers Compensation (Remote - Med Only or Minor Lost Time Claims Experience)

Join to apply for the Claims Representative - Workers Compensation (Remote - Med Only or Minor Lost Time Claims Experience) role at Sedgwick

Claims Representative - Workers Compensation (Remote - Med Only or Minor Lost Time Claims Experience)

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Join to apply for the Claims Representative - Workers Compensation (Remote - Med Only or Minor Lost Time Claims Experience) role at Sedgwick

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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 Representative - Workers Compensation (Remote - Med Only or Minor Lost Time Claims Experience)

PRIMARY PURPOSE: To process low level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements with general supervision.

ESSENTIAL FUNCTIONS And RESPONSIBILITIES

• Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
• Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.
• Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
• Administers subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• 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

Bachelor's degree from an accredited college or university preferred.

Experience

Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.

Skills & Knowledge

• Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations
  
  

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

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

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.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Finance and Sales

• Industries

  Insurance

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