Claims Associate - WC

Sedgwick Claims Management Services, Inc. King Of Prussia , PA 19406

Posted 1 week ago

Claims Associate - Workers Compensation

IF YOU CARE, THERE'S A PLACE FOR YOU HERE

For a career path that is both challenging and rewarding, join Sedgwick's talented team of 21,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets -- their employees, their customers and their property. At Sedgwick, caring counts. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.

For nearly 50 years, Sedgwick has been helping employers answer virtually every question there is about workers' compensation. We have experience in nearly every type of industry, in every region, providing the broadest range of programs and services.

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.

  • Processes assigned claims and determines benefits due pursuant to the client contract; makes timely claims payments and adjustments.

  • 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.

Experience

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

Skills & Knowledge

  • Knowledge of Social Security and Medicare application procedure as applicable to line of business

  • 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

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

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, travel as required

Auditory/Visual: Hearing, vision and talking

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

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.

Sedgwick is an Equal Opportunity Employer

and a

Drug-Free Workplace


See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Claims Representative WC

Sedgwick Claims Management Services, Inc.

Posted 2 months ago

VIEW JOBS 11/9/2018 12:00:00 AM 2019-02-07T00:00 Claims Representative - Workers Compensation IF YOU CARE, THERE'S A PLACE FOR YOU HERE For a career path that is both challenging and rewarding, join Sedgwick's talented team of 21,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets -- their employees, their customers and their property. At Sedgwick, caring counts®. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others. For nearly 50 years, Sedgwick has been helping employers answer virtually every question there is about workers' compensation. We have experience in nearly every type of industry, in every region, providing the broadest range of programs and services. 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. ADDITIONAL FUNCTIONS and RESPONSIBILITIES * Performs other duties as assigned. * Supports the organization's quality program(s). * Travels as required. QUALIFICATION 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 practices and Social Security and Medicare application procedure as applicable to line of business * Excellent oral and written communication, including presentation 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 Service Expectations WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. 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, travel as required Auditory/Visual: Hearing, vision and talking NOTE: Credit security clearance, confirmed via a background credit check, is required for this position. 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. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace Sedgwick Claims Management Services, Inc. King Of Prussia PA

Claims Associate - WC

Sedgwick Claims Management Services, Inc.