Claims Associate - Workers' Compensation
Sedgwick
Corporate Headquarters
5d ago

PRIMARY PURPOSE

To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

  • Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.
  • Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
  • Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency.
  • Communicates claim action / processing with claimant, client and appropriate medical contact.
  • Ensures claim files are properly documented and claims coding is correct.
  • May process routine payments and prescriptions and status reports for lifetime medical claims and / or defined period medical claims.
  • Maintains professional client relationships.
  • ADDITIONAL FUNCTIONS and RESPONSIBILITIES

  • Performs other duties as assigned.
  • Supports the organization's quality program(s).
  • QUALIFICATION

    Education & Licensing

    High school diploma or GED required. Licenses as required.

    Experience

    One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.

    Skills & Knowledge

  • Excellent oral and written communication skills
  • PC literate, including Microsoft Office products
  • Analytical and interpretive skills
  • Strong organizational skills
  • Good interpersonal skills
  • Ability to work in a team environment
  • Ability to meet or exceed Performance Competencies
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