Workers Compensation Claims Representative
Telecommuter GA
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. Itās an opportunity to do something meaningful, each and every day. Itās having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.Ā
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if youāre someone who cares, thereās a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to WorkĀ®
Most Loved WorkplaceĀ®Ā
Forbes Best-in-State Employer
PRIMARY PURPOSE: To process low level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements with general supervision.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
- Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.
- Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
- Administers subrogation of claims and negotiates settlements.
- Communicates claim action with claimant and client.
- Ensures claim files are properly documented and claims coding is correct.
- May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
- Maintains professional client relationships.Ā
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travels as required.
QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university preferred.
Experience
Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.
Skills & Knowledge
- Developing knowledge of regulations, offsets and deductions, disability duration, medical management ā¦
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RestrictionsTelecommuter
Benefits/PerksCareer growth Comprehensive benefits Comprehensive benefits package Dental Disability Employee assistance Flexibility Health savings account Life Insurance Medical PTO Support for mental and physical needs Vision
Tasks- Determine benefits
- Maintain client relationships
- Negotiate settlements
- Travel as required
Adjudication Analytical Claims management Communication Discretion Documentation Flexibility Interpersonal Microsoft Office Microsoft Office products Negotiation Organizational PC literate Presentation Subrogation Supervision Training Troubleshooting Workers Compensation Written communication
Experience2 years
Education Timezones