Medical-Only Workers’ Comp Claims Specialist

Sedgwick Claims Management Services Ltd; Columbus (OH); Hybrid; USD 25,000 - 36,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentive program

Career development & growth

Benefits package

Job summary

Sedgwick Claims Management Services Ltd in Dublin, OH is seeking a driven Claims Associate to analyze reported lower-level workers’ compensation claims and determine benefits due. The role offers a hybrid schedule with office or remote options depending on distance.

You will support other claims representatives on larger cases, process routine payments and prescriptions, maintain accurate documentation, and cultivate professional client relationships.

Qualifications

• High school diploma or GED required.
• One year of general office experience or equivalent combination of education and experience required.
• Medical terminology background.
• Claims industry experience preferred.
• Jurisdictions: OH, IN, AL, NC, SC (location-specific).

Responsibilities

• Analyzes reported lower-level workers' compensation claims to determine benefits due; ensures ongoing adjudication within company standards and industry best practices.
• Adjusts medical-only claims and minor lost-time workers' compensation claims under close supervision.
• Processes workers' compensation claims determining compensability and benefits due; monitors reserve accuracy and files 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.

Skills

General office experience

Medical terminology

Claims experience

Claims industry experience

Education

High school diploma or GED

Job description

Sedgwick Claims Management Services Ltd in Dublin, OH is seeking a driven Claims Associate to analyze reported lower-level workers’ compensation claims and determine benefits due. The role offers a hybrid schedule with office or remote options depending on distance.

You will support other claims representatives on larger cases, process routine payments and prescriptions, maintain accurate documentation, and cultivate professional client relationships.