Remote Medical-Only Claims Specialist

Sedgwick; Detroit (MI); Hybrid; USD 41,000 - 57,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentive

Agile environment

Career development

Job summary

Sedgwick is seeking a Claims Representative - Medical Only for multi-state coverage. The role analyzes Medical Only claims, ensures adjudication within service expectations, and negotiates settlements when appropriate.

Hybrid work options available; candidates near a Sedgwick office may work 2 days in office and 3 days remote. The ideal candidate has a HS diploma or GED (Bachelor's preferred), 2 years of claims experience, and multi-state licensing requirements; strong communication and

Qualifications

• Education: High School Diploma or GED required; Bachelor's degree preferred.
• 2 years of claims management experience or equivalent.
• 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.

Skills

Claims management

Negotiation

Communication

Analytical thinking

Education

High School Diploma or GED

Bachelor's degree preferred

Job description

Sedgwick is seeking a Claims Representative - Medical Only for multi-state coverage. The role analyzes Medical Only claims, ensures adjudication within service expectations, and negotiates settlements when appropriate.

Hybrid work options available; candidates near a Sedgwick office may work 2 days in office and 3 days remote. The ideal candidate has a HS diploma or GED (Bachelor's preferred), 2 years of claims experience, and multi-state licensing requirements; strong communication and