Workers Compensation Claims Associate | Orange, CA

About the role

Join Sedgwick, a company dedicated to helping people facing unexpected challenges. We offer a supportive work environment, career growth, and a comprehensive benefits package.

Responsibilities

• Analyze reported lower-level workers compensation claims to determine benefits eligibility and ensure ongoing adjudication aligns with company standards and industry best practices.
• Handle medical-only and minor lost-time workers compensation claims under supervision.
• Assist senior claims staff with complex cases as needed.
• Determine compensability and benefits; ensure reserve accuracy and file required documentation.
• Communicate claim status with claimants, clients, and medical contacts.
• Maintain accurate documentation and correct claims coding.
• Process routine payments, prescriptions, and status reports for ongoing medical claims.
• Build and maintain professional client relationships.

Qualifications

• 1 year of general office experience or equivalent combination of education and experience required.
• Claims industry experience preferred.
• A High School Diploma or GED required.
• A Bachelor's degree from an accredited college or university preferred.
• A professional certification as applicable to line of business preferred.