Workers Compensation Claims Representative
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About The Position
At Sedgwick, 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, which emphasizes flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful every day, with support for your mental, physical, financial, and professional needs. We focus on sharpening your skills and growing your career while working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose, allowing you 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, enjoys a challenge, and above all, cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work, recognized as a Great Place to Work® and Most Loved Workplace® by Forbes as a Best-in-State Employer. As a Workers Compensation Claims Representative, your primary purpose will be to process low-level workers compensation claims to determine benefits due, ensuring ongoing adjudication of claims within company standards and industry best practices. You will also identify subrogation of claims and negotiate settlements with general supervision. Your essential functions will include processing low-level workers compensation claims, determining compensability and benefits due on long-term indemnity claims, monitoring reserve accuracy, and filing necessary documentation with state agencies. You will develop and coordinate action plans for claims resolution, return-to-work efforts, and approve claim payments. Additionally, you will communicate claim actions with claimants and clients, ensuring that claim files are properly documented and claims coding is correct. You may also 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. Maintaining professional client relationships is also a key aspect of this role.
