Claims Representative - Workers Compensation @Sedgwick Claims Management Services Inc.

[Hiring] Claims Representative - Workers Compensation @Sedgwick Claims Management Services Inc.

Mar 26, 2025 - Sedgwick Claims Management Services Inc. is hiring a remote Claims Representative - Workers Compensation. 💸 Salary: unspecified. 📍Location: USA.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.

Role Description

This role involves processing low level workers compensation claims to determine benefits due and ensure ongoing adjudication of claims within company standards and industry best practices.

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.

Qualifications

Bachelor's degree from an accredited college or university preferred.
Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.
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.

Requirements

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

Company Description

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.
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.

Similar Remote Jobs

Kickstart Your Job Search

Need advice to apply? Join our free Webinar « 3 Mistakes to Avoid When Looking For A Remote Startup Job (And What To Do Instead) »

Unlock 53,562 additional remote jobs, advanced search & email notifications

Get Access Now

Too many emails? Declutter your inbox with Meco

Your home for reading newsletters

Try for free - no card required.

Before You Apply

️

📍	Be aware of the location restriction for this remote position: USA
‼	Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more.

Back to Remote jobs > Customer Service

Claims Representative - Workers Compensation @Sedgwick Claims Management Services Inc.

Customer Service

Salary 💸 unspecified	Remote Location USA
Job Type full-time	Posted Mar 26, 2025

Apply for this position Unlock 53,562 Remote Jobs

️

📍	Be aware of the location restriction for this remote position: USA
‼	Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more.

Claims Representative - Workers Compensation Apply for this position Unlock 53,562 Remote Jobs

[Hiring] Claims Representative - Workers Compensation @Sedgwick Claims Management Services Inc.

Similar Remote Jobs

More jobs at Sedgwick Claims Management Services Inc.

More Customer Service jobs

More jobs in USA

Kickstart Your Job Search

Get daily remote job opportunities in your inbox