Workers Compensation Claims Representative – Medical Only VA Jurisdiction
Sedgwick
full-time
Posted on:
Location Type: Remote
Location: Virginia • United States
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About the role
- Analyze Virginia Medical Only claims on behalf of our valued clients to determine benefits due.
- Ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
- Process low level workers compensation claims determining compensability and benefits due on long term indemnity claims.
- Develop and coordinate low level workers compensation claims' action plans to resolution, return-to-work efforts, and approve claim payments.
- Approve and process assigned claims, determine benefits due, and administer action plan pursuant to the claim or client contract.
- Administer subrogation of claims and negotiate settlements.
- Communicate claim action with claimant and client.
- Ensure claim files are properly documented and claims coding is correct.
- Maintain professional client relationships.
Requirements
- 2 years of claims management experience or equivalent combination of education and experience required.
- High School Diploma or GED required.
- Bachelor's degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
- Jurisdiction Knowledge: VA
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 & Tools
claims managementworkers compensation claims processingclaims adjudicationclaims codingsubrogation of claimsnegotiation of settlementsaction plan developmentbenefits determinationlong term indemnity claims processing
Soft Skills
communicationclient relationship managementorganizational skillsproblem-solving
Certifications
professional certification in claims management