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Sedgwick · 4 weeks ago

Claims Representative - Workers Compensation | Jurisdiction: Multi State | TX/FL/OK/LA License preferred (Remote/Hybrid)

Plano, TX

Full-time

Hybrid

Entry, Mid Level

2+ years exp

Sedgwick is a global industry leader dedicated to helping people facing the unexpected. The Claims Representative will adjudicate complex customer claims, deliver innovative solutions, and ensure the ongoing adjudication of claims within company standards.

BankingInsuranceRisk Management

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

Performs other duties as assigned

Supports the organization's quality program(s)

Travels as required

Qualification

Claims managementWorkers compensationNegotiationDocumentationBachelor's degreeEmpathyInclusionCollaborationGrowth

Required

Bachelor's degree from an accredited college or university

Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training

Jurisdiction: Multi State - 15 states

Licensing: Required - TX/FL/OK/LA preferred