Claims Associate - Workers Comp Med Only | Jurisdiction: Midwest | Licensing: Required TX, MI, FL (Hybrid Role)

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

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Claims Associate : Medical Only  

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands? 

• Apply your workers compensation knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.  

• Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.  

• Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.  

ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.  

WORK LOCATIONS Chicago IL - hybrid role

PRIMARY PURPOSE OF THE ROLE To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.
• Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
• Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency.
• Communicates claim action/processing with claimant, client and appropriate medical contact.
• Ensures claim files are properly documented and claims coding is correct.
• May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.
• Maintains professional client relationships.

QUALIFICATIONS 

Education & Licensing
High school diploma or GED required. Licenses as required.

Experience
One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.

Licensing / Jurisdiction Knowledge: Licensing required, TX, MI, or FL

TAKING CARE OF YOU  

• Flexible work schedule.  

• Referral incentive program.  

• Opportunity to work in an agile environment. [If Applicable]  

• Career development and promotional growth opportunities.  

• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. 

WORK ENVIRONMENT REQUIREMENTS INCLUDE  
When 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 deadlines 

Physical: Computer keyboarding, [travel as required (leave travel statement only if applicable)]  

Auditory/Visual: Hearing, vision and talking 

NOTE  

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. 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 jurisdiction noted in this job posting only, the range of starting pay for this role is ($19.87-$27.82). 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. i.e. #claimsexaminer #claims #hybrid

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.