Claims Associate – Workers Compensation, Med Only

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

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Sedgwick

WebsiteLinkedInAll Job Openings

10,000+ employees

🏗️ Construction

💼 Consulting

🏥 Healthcare

Construction • Consulting • Healthcare

Sedgwick is a global provider of technology-enabled risk, benefits, and integrated business solutions. They help people and organizations by managing and mitigating risk with solutions in accident, health, disability, unemployment compensation, and liability claims administration, among others. Sedgwick offers services such as claims administration, building consulting, forensic accounting, and forensic engineering. Their specialties include property restoration, brand protection, and loss prevention across several industries, including agriculture, construction, and environmental sectors. The company emphasizes diversity, equity, and inclusion (DEI) as well as environmental, social, and governance (ESG) practices.

📋 Description

• Analyze medical-only claims on behalf of clients to determine benefits due • Adjust medical-only claims and minor lost-time workers compensation claims under close supervision • Support claims representatives, examiners, and leads with larger or more complex claims • Process workers compensation claims, determining compensability and benefits due • Monitor reserve accuracy and file necessary documentation with the state agency • Communicate claim actions and processing with claimants, clients, and appropriate medical contacts • Ensure claim files are properly documented and claims coding is correct • Process routine payments, prescriptions, and status reports for lifetime or defined-period medical claims • Maintain professional client relationships • Support the organization's quality programs • Perform other assigned duties

🎯 Requirements

• 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 • One (1) year of general office experience or equivalent combination of education and experience required • Claims industry experience preferred • 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 • Ability to meet deadlines • Computer keyboarding • Travel as required • Hearing, vision, and talking abilities • Ability to work within applicable claims licensing/jurisdiction requirements

🏖️ Benefits

• Flexible work schedule • Referral incentive program • Opportunity to work in an agile environment • Career development and promotional growth opportunities • Medical, dental, and vision benefits on day one • 401K on day one • Reasonable accommodations when applicable and appropriate