Friday, February 1, 2013

Claims Associate - Workers Compensation - CA job from Insurance ...

Workers Compensation Claims Associate (Medical Only)


Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick has a strong commitment to its colleagues and its clients. If you are seeking place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick is the place for you. As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as the Best TPA in America and the coveted Employer of Choice designation, we invite you to come be a part of our team and, ?Claim Your Future.?

PRIMARY PURPOSE : 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.


  • 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.
  • Processes assigned claims and determines benefits due pursuant to the client contract; makes timely claims payments and adjustments.
  • 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.

  • Performs other duties as assigned.
  • Supports the organization's quality program(s).
  • Travels as required.

    Education & Licensing
    High school diploma or GED required.

    One (1) year of general office experience required. Claims industry experience preferred. Licenses as required. Any college degree may be substituted for the required experience.

    Skills & Knowledge

    • Knowledge of Social Security and Medicare application procedure as applicable to line of business
    • Excellent oral and written communication skills
    • PC literate, including Microsoft Office products
    • Analytical and interpretive skills
    • Strong organizational skills
    • Good interpersonal skills
    • Ability to work in a team environment
    • Ability to meet or exceed Performance Competencies

    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

    NOTE : 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.

    Sedgwick is an Equal Opportunity Employer

    and a

    Drug-Free Workplace

    Additional Information: NA
    Requisition #: 11693


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