Claims Representative

Join Sedgwick, a company deeply committed to supporting individuals through life's unexpected challenges. We are actively recruiting motivated and service-focused candidates for our comprehensive Workers Compensation Training Program. This entry-level trainee role offers extensive training and significant opportunities for career advancement within our organization.

Responsibilities include:

• Successful attendance and completion of the specialized claims professional training program.
• Managing various levels of workers’ compensation claims under close supervision, which involves:
• Processing and responding to incoming mail, emails, and other claim-related documents based on the claim's current status.
• Effectively communicating with injured workers, insureds/employers, medical providers, attorneys, and carrier representatives via telephone, video conference, and email.
• Conducting thorough investigations of new and existing claims by collecting pertinent information such as medical records, employer reports, and witness statements. This includes verifying employer/employee relationships, confirming policy coverage, identifying potential subrogation issues, and detecting fraud indicators.
• Determining coverage, compensability, and the appropriate benefits in alignment with jurisdictional guidelines and carrier program requirements.
• Accurately documenting claims files and coding claim activities. Preparing detailed reports that outline findings and recommendations.
• Administering claim benefits, including indemnity and medical payments, by maintaining a system of calendared claim-related action items to ensure compliance with state regulations.
• Participating in virtual and/or in-person meetings, claim reviews, and business functions as necessary for educational purposes, claim discussions, and other meetings.