Claims Representative – Workers Compensation, Multi State
Sedgwick
full-time
Posted on:
Location Type: Hybrid
Location: Plano • Florida, Louisiana, Oklahoma, Texas • 🇺🇸 United States
Visit company websiteJob Level
JuniorMid-Level
About the role
- 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.
Requirements
- 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.
- Jurisdiction: Multi State - 15 states Licensing: Required - TX/FL/OK/LA preferred
Benefits
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims managementworkers compensation claims processingbenefits determinationclaims codingsubrogationsettlement negotiationaction plan administrationmedical claims processingutilization review
Soft skills
communicationclient relationship managementorganizational skills
Certifications
Bachelor's degreeClaims Representative training