Claims Representative - Workers Compensation

About the Role

Join Sedgwick, a global industry leader, to adjudicate complex workers compensation claims and deliver innovative customer-facing solutions for some of the world’s most respected organizations. As a Claims Representative, you’ll process low-level workers compensation claims, determine benefits due, ensure ongoing adjudication within company standards, and identify subrogation opportunities. This role offers flexibility, autonomy, and opportunities for professional growth within a rapidly expanding company known for excellence and customer service.

Responsibilities

• Process low-level workers compensation claims to determine compensability and benefits due, monitor reserve accuracy, and file necessary documentation with state agencies.
• Develop and coordinate action plans for claims resolution, return-to-work efforts, and approve claim payments.
• Administer subrogation of claims and negotiate settlements.
• Communicate claim actions with claimants and clients.
• Ensure proper documentation of claim files and correct claims coding.
• 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.
• Perform other duties as assigned, support quality programs, and travel as required.

Requirements

• Two (2) years of claims management experience or equivalent combination of education and experience, or successful completion of Claims Representative training.
• Jurisdiction knowledge of Colorado preferred.
• Texas or Indiana license that can reciprocate preferred.

Qualifications

• Bachelor’s degree from an accredited college or university preferred.

Benefits

• Flexible work schedule.
• Referral incentive program.
• Career development and promotional growth opportunities.
• Comprehensive benefits package including medical, dental, vision, and 401K with matching (available on day one).
• Additional voluntary benefits such as disability and life insurance, employee assistance, flexible spending or health savings account.

Pay

For the jurisdiction noted in this job posting, the range of starting pay for this role is $46,125.00 - $64,575.00.