What are the responsibilities and job description for the Claims Representative - Workers Compensation | Meridian, ID position at York Risk Services?
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 Representative - Workers Compensation | Meridian, IDPRIMARY 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.
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.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE
Processes low level 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 coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.
Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
Administers 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 low-level 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.
QUALIFICATIONS
Education & Licensing: 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.
Jurisdiction Knowledge:
Licensing:
TAKING CARE OF YOU
Flexible work schedule.
Referral incentive program.
Opportunity to work in an agile environment.
Career development and promotional growth opportunities.
A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
WORK ENVIRONMENT
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
Auditory/Visual:Hearing, vision and talking
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.
Sedgwickis 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.