Remote Medical Claims Specialist | Hybrid Option

Sedgwick; Montpelier (VT); Remote; USD 41,000 - 57,000; Full time

Benefits offered by this job

Flexible schedule

Referral program

Agile environment

Career growth

Benefits on day one

Job summary

Sedgwick is seeking a Claims Representative - Med Only to analyze Medical Only claims, determine benefits, and adjudicate within service standards for our clients.

Hybrid work is available within 25 miles of a Sedgwick office (2 days in office, 3 days remote); others may work fully remote.

Requirements: High School Diploma or GED; Bachelor's degree preferred; 2 years of claims experience; multi-state knowledge; Home State licensing. A comprehensive benefits package is offered.

Qualifications

• High School diploma or GED required; Bachelor's degree preferred.
• 2 years of claims management experience required.
• Multi-state jurisdiction knowledge.
• Home State licensing required.

Responsibilities

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

Skills

Claims processing

Multistate knowledge

Education

High School Diploma or GED

Bachelor's degree preferred

Professional certification preferred

Job description

Sedgwick is seeking a Claims Representative - Med Only to analyze Medical Only claims, determine benefits, and adjudicate within service standards for our clients.

Hybrid work is available within 25 miles of a Sedgwick office (2 days in office, 3 days remote); others may work fully remote.

Requirements: High School Diploma or GED; Bachelor's degree preferred; 2 years of claims experience; multi-state knowledge; Home State licensing. A comprehensive benefits package is offered.