Claims Representative - Workers Compensation | Jurisdiction: IL, IN, KS, MI, MO,
Sedgwick, Lansing, MI, United States
Claims Representative – Workers Compensation
Jurisdiction: IL, IN, KS, MI, MO, NE, WI, MN
Licensing: Reciprocal License Preferred
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 including state and physician filings and decisions on appropriate treatments recommended by utilization review.
Maintain professional client relationships.
Qualifications
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.
Legislative & Licensing
Jurisdiction Knowledge: IL, IN, KS, MI, MO, NE, WI, MN.
Licensing: Reciprocal license preferred.
Benefits and Development
Flexible work schedule.
Referral incentive program.
Opportunity to work in an agile environment.
Career development and promotional growth opportunities.
Diverse and comprehensive benefits offering including medical, dental, vision, 401(k) on day one.
Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace.
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Licensing: Reciprocal License Preferred
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 including state and physician filings and decisions on appropriate treatments recommended by utilization review.
Maintain professional client relationships.
Qualifications
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.
Legislative & Licensing
Jurisdiction Knowledge: IL, IN, KS, MI, MO, NE, WI, MN.
Licensing: Reciprocal license preferred.
Benefits and Development
Flexible work schedule.
Referral incentive program.
Opportunity to work in an agile environment.
Career development and promotional growth opportunities.
Diverse and comprehensive benefits offering including medical, dental, vision, 401(k) on day one.
Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace.
#J-18808-Ljbffr