Future Medical Claims Representative | Concord, CA

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 Workers Compensation | Claims Representative (Future Medical)| In-Office (Concord, CA)

• 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.

• OFFICE LOCATIONS

• Concord, CA

• PRIMARY PURPOSE

• : 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.

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ESSENTIAL

FUNCTIONS and

RESPONSIBILITIES

• + 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.
• Skills & Knowledge
• + Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business + Excellent oral and written communication, including presentation 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 Service Expectations •

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. _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 $25 - $32 hourly. 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._ Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. 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.
• Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected.

The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see

• sedgwick.com

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