Remote Medical Claims Specialist

Sedgwick; Naperville (IL); Hybrid; USD 41,000 - 57,000; Full time

Benefits offered by this job

Referral incentive

Flexible schedule

Benefits on day one

Job summary

Sedgwick is hiring a Claims Representative - Med Only (Multi State) with hybrid work options. This role analyzes Medical Only claims, determines benefits, and ensures adjudication aligns with client service requirements.

Hybrid schedule favors those near Sedgwick offices, with remote options for others. Candidates must have at least a high school diploma (bachelor's preferred) and 2 years of claims experience.

Qualifications

• Education & Licensing: 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.
• Experience: 2 years of claims management experience or equivalent combination of education and experience required.
• Jurisdiction Knowledge: Multi State
• Licensing: Home State Required

Responsibilities

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Education

High School Diploma or GED

Bachelor's degree

Job description

Sedgwick is hiring a Claims Representative - Med Only (Multi State) with hybrid work options. This role analyzes Medical Only claims, determines benefits, and ensures adjudication aligns with client service requirements.

Hybrid schedule favors those near Sedgwick offices, with remote options for others. Candidates must have at least a high school diploma (bachelor's preferred) and 2 years of claims experience.