Claims Associate – Work Compensation Medical Only
Sedgwick
full-time
Posted on:
Location Type: Hybrid
Location: Plano • Texas • United States
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About the role
- Analyzes reported lower-level workers compensation claims to determine benefits due.
- Ensures ongoing adjudication of claims within company standards and industry best practices.
- 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.
Requirements
- High school diploma or GED required.
- Licenses as required.
- One (1) year of general office experience or equivalent combination of education and experience required.
- Claims industry experience preferred.
- Jurisdiction Knowledge: CO, UT, WA, OR and TN Licensing: TX/FL preferred.
Benefits
- Flexible work schedule.
- Referral incentive program.
- Opportunity to work in an agile environment.
- 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 processingadjudicationmedical-only claims adjustmentclaims codingreserve accuracy monitoringdocumentation filingroutine payments processingprescription processingstatus report generationcompensability determination
Soft skills
communicationclient relationship managementteam supportattention to detailorganizational skills
Certifications
high school diplomaGEDstate licensing (TX/FL preferred)