Offer summary

Qualifications:

High school diploma or GED required; licenses as required., One year of general office experience or equivalent education and experience; claims industry experience preferred., Excellent oral and written communication skills; PC literate including Microsoft Office products., Strong organizational and analytical skills with the ability to work in a team environment..

Key responsibilities:

Adjusts medical-only and minor lost-time workers compensation claims under supervision.

Processes claims to determine compensability and benefits due, ensuring documentation is filed with state agencies.

Communicates claim actions with claimants, clients, and medical contacts, maintaining professional relationships.

Supports other claims representatives with larger or complex claims as necessary and performs additional duties as assigned.

Job description

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Claims Adjuster - Workers Compensation - Telecommute OR

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

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

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.

#LI-Remote

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.