Claims Representative - Workers Compensation | Jurisdiction: IL, IN, KS, MI, MO,
Sedgwick, Detroit, MI, United States
Primary Purpose of the Role
To process low‑level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements with general supervision.
Essential Responsibilities
Process low‑level workers compensation claims determining compensability and benefits due on long‑term indemnity claims, monitor reserve accuracy, and file necessary documentation with state agency.
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.
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.
Maintain professional client relationships.
Qualifications Education & Licensing: 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: IL, IN, KS, MI, MO, NE, WI and MN
Licensing: Reciprocal license 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, and 401K on day one.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
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Essential Responsibilities
Process low‑level workers compensation claims determining compensability and benefits due on long‑term indemnity claims, monitor reserve accuracy, and file necessary documentation with state agency.
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.
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.
Maintain professional client relationships.
Qualifications Education & Licensing: 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: IL, IN, KS, MI, MO, NE, WI and MN
Licensing: Reciprocal license 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, and 401K on day one.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
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