Workers Compensation - Claims Representative | Jurisdiction: TX, OK, LA | Licensing: TX Required (Hybrid)

Sedgwick Claims Management Services Ltd; Plano (TX); Hybrid; USD 42,000 - 64,000; Full time

Benefits offered by this job

Referral incentive

Agile environment

Career development

Benefits package

Job summary

Sedgwick in Plano, TX is seeking a Workers' Compensation Claims Representative for a hybrid role with 3 days in office and 2 days remote. You will analyze claims, determine benefits due, and adjudicate within service expectations and client requirements.

The ideal candidate has a High School Diploma or GED (Bachelor's preferred) and at least 2 years of claims management experience. TX licensing is required and OK/LA licensing is preferred.

Qualifications

• High School Diploma or GED required; Bachelor's degree preferred.
• Minimum 2 years of claims management experience.
• TX license required; OK/LA licenses preferred.

Responsibilities

• Analyze workers' compensation claims to determine benefits due.
• Investigate and gather information to support claim exposure assessment.
• Negotiate settlements within designated authority and communicate with claimants and clients.

Skills

Claims analysis

Negotiation

Communication

Reporting

Adjudication

Education

High School Diploma or GED

Bachelor's degree preferred

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 Workers Compensation - Claims Representative | Jurisdiction: TX, OK, LA | Licensing: TX Required (Hybrid) Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands? Apply your Workers Compensation knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

WORK LOCATIONS:

3 day in office, 2 days remote in our Plano, TX office.

PRIMARY PURPOSE OF THE ROLE

To analyze Workers Compensation claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• 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.

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.

Licensing: TX Required and OK, LA preferred.

Jurisdiction Knowledge: TX, OK, LA.

TAKING CARE OF YOU

Flexible work schedule.

• Referral incentive program.
• Opportunity to work in an agile environment.
• Career development and promotional growth opportunities.
• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

WORK ENVIRONMENT REQUIREMENTS INCLUDE

• Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
• Physical: Computer keyboarding
• Auditory/Visual: Hearing, vision and talking

#claimsexaminer #claims #hybrid #LI-REMOTE

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.

Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

For more, see sedgwick.com