Workers Compensation Claims Adjuster
Company: Sedgwick
Location: Orange
Posted on: January 27, 2023
Job Description:
Taking care of people is at the heart of everything we do, and
we start by taking care of you, our valued colleague. A career at
Sedgwick means experiencing our culture of caring. It means having
flexibility and time for all the things that are important to you.
Its an opportunity to do something meaningful, each and every day.
Its having support for your mental, physical, financial and
professional needs. It means sharpening your skills and growing
your career. And it means working in an environment that celebrates
diversity and is fair and inclusive.A career at Sedgwick is where
passion meets purpose to make a positive impact on the world
through the people and organizations we serve. If you are someone
who is driven to make a difference, who enjoys a challenge and
above all, if youre someone who cares, theres a place for you here.
Join us and contribute to Sedgwick being a great place to
work.Great Place to WorkMost Loved WorkplaceForbes Best-in-State
EmployerWorkers Compensation Claims AdjusterPRIMARY PURPOSE : To
analyze mid- and higher-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.ESSENTIAL
FUNCTIONS and RESPONSIBILITIES
- Manages workers compensation claims determining compensability
and benefits due on long term indemnity claims, monitors reserve
accuracy, and files necessary documentation with state agency.
- Develops and manages workers compensation claims' action plans
to resolution, coordinates return-to-work efforts, and approves
claim payments.
- Approves and processes assigned claims, determines benefits
due, and manages action plan pursuant to the claim or client
contract.
- Manages subrogation of claims and negotiates settlements.
- Communicates claim action with claimant and client.
- Ensures claim files are properly documented and claims coding
is correct.
- May process complex lifetime medical and/or defined period
medical claims which include state and physician filings and
decisions on appropriate treatments recommended by utilization
review.
- Maintains professional client relationships.ADDITIONAL
FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travels as required.QUALIFICATIONSEducation &
LicensingBachelor's degree from an accredited college or university
preferred.ExperienceFour (4) years of claims management experience
or equivalent combination of education and experience
required.Skills & Knowledge
- Working knowledge of regulations, offsets and deductions,
disability duration, medical management practices and Social
Security and Medicare application procedure as applicable to line
of business
- Excellent oral and written communication, including
presentation skills
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skill
- Good interpersonal skills
- Excellent negotiation skills
- Ability to work in a team environment
- Ability to meet or exceed Service ExpectationsWORK
ENVIRONMENTWhen applicable and appropriate, consideration will be
given to reasonable accommodations.Mental : 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; and
ability to meet deadlinesPhysical : Computer keyboarding, travel as
requiredAuditory/Visual : Hearing, vision and talkingNOTE : Credit
security clearance, confirmed via a background credit check, is
required for this position.The statements contained in this
document are intended to describe the general nature and level of
work being performed by a colleague assigned to this description.
They are not intended to constitute a comprehensive list of
functions, duties, or local variances. Management retains the
discretion to add or to change the duties of the position at any
time.As required by law, Sedgwick provides a reasonable range of
compensation for roles that may be hired in California, Colorado,
New York City, or Washington. Actual compensation is influenced by
a wide range of factors including but not limited to skill set,
level of experience, and cost of specific location. For the state
noted in this job posting only, the range of starting pay for this
role is $ 53,973.00 - 75,562.00 . A comprehensive benefits package
is offered including but not limited to, medical, dental, vision,
401k and matching, PTO, disability and life insurance, employee
assistance, flexible spending or health savings account, and other
additional voluntary benefits.Sedgwick is an Equal Opportunity
Employer and a Drug-Free Workplace.If you're excited about this
role but your experience doesn't align perfectly with every
qualification in the job description, consider applying for it
anyway! Sedgwick is building a diverse, equitable, and inclusive
workplace and recognizes that each person possesses a unique
combination of skills, knowledge, and experience. You may be just
the right candidate for this or other roles.Taking care of people
is at the heart of everything we do. Caring countsSedgwick is a
leading global provider of technology-enabled risk, benefits and
integrated business solutions. Every day, in every time zone, the
most well-known and respected organizations place their trust in us
to help their employees regain health and productivity, guide their
consumers through the claims process, protect their brand and
minimize business interruptions. Our more than 30,000 colleagues
across 80 countries embrace our shared purpose and values as they
demonstrate what it means to work for an organization committed to
doing the right thing one where caring counts. Watch this video to
learn more about us.
(https://www.youtube.com/watch?v=ywxedjBGSfA)
Keywords: Sedgwick, Orange , Workers Compensation Claims Adjuster, Other , Orange, California
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