Work Comp Claims Services Associate | Hybrid | Sacramento, CA

Sedgwick Claims Management Services; Sacramento (CA); Hybrid; USD 34,000 - 41,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401k with matching

PTO and life/disability insurance

Employee assistance

Job summary

Sedgwick Claims Management Services is seeking a Work Comp Claims Services Associate for a hybrid role in Sacramento, CA. The position involves reviewing California workers' compensation information, communicating with medical facilities, clients, and staff, and guiding claims toward resolution with attention to accuracy and compliance.

The role emphasizes data collection, file audits, and coordination of forms and payments.

Qualifications

• Two (2) years of claims experience or equivalent combination of education and experience required.
• High school diploma or GED required.
• Knowledge of state workers' compensation statute.
• Proficient math skill.
• Excellent oral and written communication, including presentation skills.
• PC literate, including Microsoft Office products.

Responsibilities

• Provides initial research/data collection on claims file.
• Performs file audits according to jurisdictional standards as directed by state, carrier, or client.
• Reviews prior audit results, settled files, or files with no activity and identifies exceptions.
• Coordinates file retrieval and gathers data for submittal to management.
• Communicates with claim examiners to correct identified deficiencies by providing corrected payment amount and instructions regarding necessary state form filing.
• Monitors correction of audit exceptions ensuring completion and assists with filing of state forms and submitting payments as necessary.
• Researches exceptions on the state's quarterly compliance report and provides detailed response to management identifying trends in audit exceptions.
• Reviews and updates notes/diaries in claims management system as instructed.
• Coordinates jurisdictional training on state specific tools.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

Skills

State workers' compensation statute

Math proficiency

Oral and written communication

Teamwork

Meeting performance competencies

Education

High school diploma or GED

Tools

Excel

Job description

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Work Comp Claims Services Associate | Hybrid | Sacramento, CA

Are you looking for an impactful job that offers an opportunity to develop a professional career?

• This role is hybrid 2 days in the Sacramento, CA Sedgwick office and 3 days' work at home*
• Career development and promotional growth opportunities through increasing responsibilities
• A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs

PRIMARY PURPOSE OF THE ROLE: The Claims Services Associate is an important part of the services provided as they work closely with the Workers' Compensation Program Managers to receive, review, and document California workers' compensation information as directed. The Associate communicates regularly when needed with medical facilities, third-party administrators, clients, and staff. With the Associate's skills and knowledge, the Associate will review documents and other third-party administrator's claims system to make recommendations when needed to staff that will move workers' compensation claims toward resolution.

ESSENTIAL RESPONSIBILITIES MAY INCLUDE:

• Provides initial research/data collection on claims file.
• Performs file audits according to jurisdictional standards as directed by state, carrier, or client.
• Reviews prior audit results, settled files, or files with no activity and identifies exceptions.
• Coordinates file retrieval and gathers data for submittal to management.
• Communicates with claim examiners to correct identified deficiencies by provides corrected payment amount and instructions regarding necessary state form filing.
• Monitors correction of audit exceptions ensuring completion and assists with filing of state forms and submitting payments as necessary.
• Researches exceptions on the state's quarterly compliance report and provides detailed response to management identifying trends in audit exceptions.
• Reviews and updates notes/diaries in claims management system as instructed.
• Coordinates jurisdictional training on state specific tools.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing: Two (2) years of claims experience or equivalent combination of education and experience required.

• High school diploma or GED required.
  

Skills & Knowledge

• Knowledge of state workers' compensation statute
• Proficient math skill
• Skilled with Excel spreadsheets
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

Work environment requirements include -

Physical: Computer keyboarding
Auditory/visual: Hearing, vision and talking
Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $25.00- $30.00 USD hourly. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.