Claims Recovery Representative

Sedgwick Claims Management Services, Inc. Sun Prairie , WI 53591

Posted 2 weeks ago

Claims Recovery Representative


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.

PRIMARY PURPOSE: To identify and pursue potential Second Injury Fund and subrogation recoveries associated with workers compensation claims.


  • Reviews workers compensation claims to determine if potential for Second Injury Fund recoveries exist.

  • Pursues medical information necessary to qualify claim for acceptance by the Second Injury Fund.

  • Pursues information necessary to satisfy the Second Injury Fund's knowledge requirement.

  • Determines from knowledge and medical information secured whether to submit claim warrants to Second Injury Fund for acceptance.

  • Approves and/or pays bills as appropriate.

  • Reviews workers' claims and conducts investigations to determine if potential for subrogation exists.

  • Gathers information necessary to support viable subrogation claim.

  • Notifies appropriate parties of subrogation lien.

  • Secures recovery from responsible parties.

  • Prepares various type status reports for clients.

  • Enters recoveries into the claims management system.

  • Obtains settlement authority from state funds and negotiates compromise settlements with state funds.


  • Performs other duties as assigned.

  • Supports the organization's quality program(s).

  • Travels as required.


Education & Licensing

Bachelor's degree from an accredited college or university preferred.


Three (3) years of claims experience or equivalent combination of education and experience required.

Skills & Knowledge

  • Thorough knowledge of claims management processes and procedures

  • Excellent oral and written communication

  • PC literate, including Microsoft Office products

  • Strong organizational skills

  • Excellent interpersonal skills

  • Ability to work in a team environment

  • Ability to meet or exceed Performance Competencies


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

Mental: Clear and conceptual thinking ability; excellent judgment 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

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

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

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 TraineeProperty

QBE Insurance Group Limited

Posted 2 weeks ago

VIEW JOBS 3/9/2019 12:00:00 AM 2019-06-07T00:00 Support the handling and review of claims for the property line of business by providing accurate documentation, communicating progress, delivering consistent customer service and assisting with special projects to complete assignments. Generally responsible for working on medium to high volume low complexity claims for assigned line(s) of business. Primary Responsibilities * Contacts all parties involved to complete full investigation (as required by line of business) of the facts and damages relevant to the claim * Identify potential coverage issues and refer claims to senior leader as needed, determine liability and damages of all exposures related to the claim and document findings of investigation * Identify and refer claims to subject matter experts in a timely manner to maximize claim outcomes * Provides effective and timely communication to all internal and external stakeholders regarding claim status and other inquiries such as fraud, subrogation recovery, reserve adequacy and underwriting risks * Evaluates and negotiates the resolution of claims within authority levels while mitigating damages to achieve cost effective claims outcomes * Support claims workflow efficiency by accurately documenting portfolio progress, referring high risk exposures outside authority levels and seeking opportunities that enhance operational * Document files in a timely fashion with all appropriate claim information * Correspond with intermediaries via email or telephone during the life of the claim * Meet established performance metrics by setting work related goals, communicating with management to report progress and assisting with assigned special projects to support the achievement of department objectives * Contribute to a positive work environment by demonstrating cultural expectations and influencing others to reward performance and value "can do" people, accountability, diversity and inclusion, flexibility, continuous improvement, collaboration, creativity and fun Preferred Qualifications Education: Bachelor's Degree or equivalent combination of education and work experience Experience: Experience in customer service or the insurance industry Licenses/Certifications: Progress toward an insurance designation such as Associate in Claims (AIC), Associate in Management (AIM), Chartered Property Casualty Underwriter (CPCU) or Senior Claim Law Associate (SCLA) Preferred Knowledge * Knowledge of claims administration best practices and procedures * Knowledge of insurance products and services * General understanding of relevant laws and regulations across multiple jurisdictions * Understanding of market trends and organizational strategies * Working knowledge of Microsoft Office Suite, general computer software and database systems * Principles and concepts for providing customer service Preferred Competencies/Skills * Utilize effective communication to effectively influence and persuade decision makers; understand the needs and goals of customers and actively look for ways to meet them * Mediate and resolve conflict using a logical approach * Identify relevant information and understand it's impact * Maintain integrity of claims portfolio and evidence * Use multiple resources to gather and analyze significant data * Properly document investigation findings in accordance with internal and external laws and procedures * Leverage technical knowledge to make cost-effective decisions * Encourage open communication, cooperation and knowledge sharing * High attention to detail * Implement planning to organize, prioritize and measure individual work * Establish and maintain effective and respectful relationships with customers QBE Cultural DNA Everything we do at QBE is underpinned by our DNA (which interlinks seven cultural elements) – because we know it's not just what we do that matters, it's how we do it that makes the difference. We expect all employees to role model and inspire the right behaviors that link to our cultural elements: * We are customer-centered * We are technical experts * We are diverse * We are fast-paced * We are courageous * We are accountable * We are a team All employees are expected to adhere to QBE's Code of Ethics and Conduct and apply sound risk management practices Work environment Travel frequency: Travel to other QBE offices may be necessary for required training. Infrequent travel may be required to support our claims response to catastrophic events. Must be willing to travel up to 4 weeks per year. Physical demands: General office jobs: Work is generally performed in an office environment in which there is not substantial exposure to adverse environmental conditions. Must have the ability to remain in a stationary position for extended periods of time. Must be able to operate basic office equipment including telephone, headset and computer. Incumbent must be able to lift basic office equipment up to 20 lbs. To successfully perform this job, the individual must be able to perform each essential job responsibility satisfactorily. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential job responsibilities. The duties listed in this job description do not limit the assignment of work. They are not to be construed as a complete list of the duties normally to be performed in the position or those occasionally assigned outside an employee's normal duties. Our Group Code of Ethics and Conduct addresses the responsibilities we all have at QBE to our company, to each other and to our customers, suppliers, communities and governments. It provides clear guidance to help us to make good judgement calls. Number of Openings: 0 How to Apply: To submit your application, click "Apply" and follow the step by step process. Equal Employment Opportunity: QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates. QBE Insurance Group Limited Sun Prairie WI

Claims Recovery Representative

Sedgwick Claims Management Services, Inc.