Workers Compensation Claims Representative – Medical Only, VA Jurisdiction
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Job Description
Workers compensation claims representative processing medical-only claims for Sedgwick, a global claims-management company. Adjudicating VA-jurisdiction claims, negotiating settlements, and communicating with claimants and clients.
Responsibilities:
- Process low-level medical-only Workers Compensation claims for a dedicated client
- Determine benefits due and ensure ongoing adjudication within company standards and industry best practices
- Identify subrogation claims and negotiate settlements with general supervision
- Analyze and process claims through action plans to achieve appropriate and timely resolution
- Investigate claims and gather information to determine claim exposure
- Negotiate claim settlements within designated authority
- Communicate claim activity and processing with claimants and clients
- Report claims to the excess carrier
- Respond to requests for directions professionally and promptly
- Collaborate within Sedgwick’s global network of experts and deliver customer-facing solutions
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
- Knowledge of the VA jurisdiction
- Ability to process low-level medical-only workers compensation claims
- Ability to investigate claims and gather information to determine claim exposure
- Ability to negotiate settlements within designated authority
- Ability to communicate claim activity and processing with claimants and clients
- Ability to report claims to the excess carrier and respond to requests for directions
- Must meet applicable work authorization and legal 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 and matching
- PTO
- Disability and life insurance
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
- Flexibility and autonomy in daily work, location, and career path
- Professional development opportunities
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