Med-Only Claims Specialist (Remote/Hybrid)

Sedgwick; Austin (TX); Hybrid; USD 41,000 - 57,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401(k) on day one

PTO (Paid Time Off)

Disability Insurance

Life Insurance

Employee assistance

Job summary

Sedgwick is hiring a Claims Representative - Med Only with multi-state jurisdiction, hybrid work model, and a focus on analyzing Medical Only claims to determine benefits and ensure timely adjudication. Ideal candidates have strong analytical skills, communication abilities, and a commitment to high-quality client service.

Responsibilities include claim analysis, settlement negotiations, and regular updates to clients and carriers, with growth opportunities and a comprehensive benefits package.

Qualifications

• Education: 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.

Responsibilities

• Analyze Medical Only claims to determine benefits due and adjudicate within service expectations.
• Negotiate settlements within designated authority.
• Communicate claim activity with the claimant and client.
• Report claims to the excess carrier and respond to directions professionally and timely.

Skills

Claims processing

Education

High School Diploma or GED

Bachelor's degree preferred

Job description

Sedgwick is hiring a Claims Representative - Med Only with multi-state jurisdiction, hybrid work model, and a focus on analyzing Medical Only claims to determine benefits and ensure timely adjudication. Ideal candidates have strong analytical skills, communication abilities, and a commitment to high-quality client service.

Responsibilities include claim analysis, settlement negotiations, and regular updates to clients and carriers, with growth opportunities and a comprehensive benefits package.