Claims Representative - Workers Compensation

Posted 3 Days Ago
Be an Early Applicant
2 Locations
In-Office
46K-65K Annually
Junior
Insurance
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions.
The Role
Adjudicate low-level workers' compensation claims: determine compensability and benefits, monitor reserves, develop action plans, approve payments, handle subrogation and settlements, maintain documentation and client communication, and support return-to-work and medical claim processes.
Summary Generated by Built In

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.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Claims Representative - Workers Compensation

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 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. 
  • Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights. 
  • Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career. 
  • Enjoy flexibility and autonomy in your daily work, your location, and your career path. 
  • Access diverse and comprehensive benefits to take care of your mental, physical, financial, and professional needs. 

ARE YOU AN IDEAL CANDIDATE? 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.

PRIMARY PURPOSE OF THE ROLE: 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. 

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

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

QUALIFICATIONS

Education & Licensing

Bachelor's degree from an accredited college or university preferred.

Experience

Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.

Jurisdiction Knowledge: Colorado preferred.

Licensing: Texas or Indiana license that can reciprocate preferred.

TAKING CARE OF YOU

Flexible work schedule. 

Referral incentive program. 

Career development and promotional growth opportunities. 

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

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 ( $46,125.00 - $64,575.00). 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.

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.

Skills Required

  • Two (2) years of claims management experience or equivalent combination of education and experience
  • Successful completion of Claims Representative training
  • Bachelor's degree from an accredited college or university
  • Jurisdiction knowledge: Colorado
  • State license (Texas or Indiana license that can reciprocate)

Sedgwick Compensation & Benefits Highlights

The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Sedgwick and has not been reviewed or approved by Sedgwick.

  • Leave & Time Off Breadth Generous paid time off and paid holidays are emphasized, with PTO accruals increasing with tenure. Paid parental leave and caregiver support further expand time-off coverage.
  • Healthcare Strength Medical, dental and vision coverage is complemented by telemedicine and a personal health concierge. Wellbeing supports such as diabetes and weight-management programs, fertility services, and robust mental-health access (coaching, therapy, psychiatry) broaden care.
  • Parental & Family Support Paid parental leave and caregiver support are offered alongside family-forming resources. Fertility services and adoption assistance reinforce family-oriented benefits.

Sedgwick Insights

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The Company
HQ: Memphis, TN
31,000 Employees
Year Founded: 1969

What We Do

From our modest beginnings as a regional claims administrator, Sedgwick has grown into a leading global provider of technology-enabled risk, benefits and integrated business solutions with 31,000+ colleagues, located across 80 countries. Through innovative product development, organic business development and strategic acquisitions, Sedgwick’s offerings continue to evolve beyond claims processing to meet the current and future needs of our clients. Our approach to delivering quality service in areas such as workers’ compensation, liability, property, disability and absence management goes far beyond just managing claims—we aim to simplify the process and reduce complexity, making it easy and effective for everyone involve.

Why Work With Us

We stay tuned into what our colleagues want and need and deliver a world-class colleague experience that demonstrates how much we value their unique contributions to our business. You’ll see and feel what it’s like to work for a company that’s committed to doing the right thing – for those we serve, for our planet and for each other.

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