Hybrid Work Comp Claims Specialist – Sacramento

Sedgwick Claims Management Services; Sacramento (CA); Hybrid; USD 34,000 - 41,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401k with matching

PTO and life/disability insurance

Employee assistance

Job summary

Sedgwick Claims Management Services is seeking a Work Comp Claims Services Associate for a hybrid role in Sacramento, CA. The position involves reviewing California workers' compensation information, communicating with medical facilities, clients, and staff, and guiding claims toward resolution with attention to accuracy and compliance.

The role emphasizes data collection, file audits, and coordination of forms and payments.

Qualifications

• Two (2) years of claims experience or equivalent combination of education and experience required.
• High school diploma or GED required.
• Knowledge of state workers' compensation statute.
• Proficient math skill.
• Excellent oral and written communication, including presentation skills.
• PC literate, including Microsoft Office products.

Responsibilities

• Provides initial research/data collection on claims file.
• Performs file audits according to jurisdictional standards as directed by state, carrier, or client.
• Reviews prior audit results, settled files, or files with no activity and identifies exceptions.
• Coordinates file retrieval and gathers data for submittal to management.
• Communicates with claim examiners to correct identified deficiencies by providing corrected payment amount and instructions regarding necessary state form filing.
• Monitors correction of audit exceptions ensuring completion and assists with filing of state forms and submitting payments as necessary.
• Researches exceptions on the state's quarterly compliance report and provides detailed response to management identifying trends in audit exceptions.
• Reviews and updates notes/diaries in claims management system as instructed.
• Coordinates jurisdictional training on state specific tools.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

Skills

State workers' compensation statute

Math proficiency

Oral and written communication

Teamwork

Meeting performance competencies

Education

High school diploma or GED

Tools

Excel

Job description

Sedgwick Claims Management Services is seeking a Work Comp Claims Services Associate for a hybrid role in Sacramento, CA. The position involves reviewing California workers' compensation information, communicating with medical facilities, clients, and staff, and guiding claims toward resolution with attention to accuracy and compliance.

The role emphasizes data collection, file audits, and coordination of forms and payments.