Claims Representative - Workers Compensation
Company: Sedgwick
Location: Cedar Rapids
Posted on: May 23, 2023
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Job Description:
Taking care of people is at the heart of everything we do, and
we start by taking care of you, our valued colleague. A career at
Sedgwick means experiencing our culture of caring. It means having
flexibility and time for all the things that are important to you.
It's an opportunity to do something meaningful, each and every day.
It's having support for your mental, physical, financial and
professional needs. It means sharpening your skills and growing
your career. And it means working in an environment that celebrates
diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a
positive impact on the world through the people and organizations
we serve. If you are someone who is driven to make a difference,
who enjoys a challenge and above all, if you're someone who cares,
there's a place for you here. Join us and contribute to Sedgwick
being a great place to work.
Great Place to Work -
Most Loved Workplace -
Forbes Best-in-State Employer
Claims Representative - Workers Compensation
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.
QUALIFICATIONS
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.
If you're excited about this role but your experience doesn't align
perfectly with every qualification in the job description, consider
applying for it anyway! Sedgwick is building a diverse, equitable,
and inclusive workplace and recognizes that each person possesses a
unique combination of skills, knowledge, and experience. You may be
just the right candidate for this or other roles.
Taking care of people is at the heart of everything we do. Caring
counts
Sedgwick is a leading global provider of technology-enabled risk,
benefits and integrated business solutions. Every day, in every
time zone, the most well-known and respected organizations place
their trust in us to help their employees regain health and
productivity, guide their consumers through the claims process,
protect their brand and minimize business interruptions. Our more
than 30,000 colleagues across 80 countries embrace our shared
purpose and values as they demonstrate what it means to work for an
organization committed to doing the right thing - one where caring
counts. Watch this video to learn more about us.
(https://www.youtube.com/watch?v=ywxedjBGSfA)
Keywords: Sedgwick, Cedar Rapids , Claims Representative - Workers Compensation, Other , Cedar Rapids, Iowa
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