Claims Adjuster - Workers Compensation - (Dedicated Client) Job at Sedgwick, Ontario, CA

WEttVm4wdnZ6dlgzYUhlUkNkT3dzNVRz
  • Sedgwick
  • Ontario, CA

Job Description

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Place to Work® Most Loved Workplace® Forbes Best-in-State Employer Claims Adjuster - Workers Compensation - (Dedicated Client) **PRIMARY PURPOSE** **:** To analyze mid- and higher-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. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Manages 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 manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments. + Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract. + Manages 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 complex 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** Four (4) years of claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + Working 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 skill + Good interpersonal skills + Excellent negotiation 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 $75,000 - $102,000 per year_ _. 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._ \#LI-HYBRID #LI-DV1 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.** **Taking care of people is at the heart of everything we do. Caring counts** Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (

Job Tags

Contract work, Work at office, Local area, Flexible hours,

Similar Jobs

Confidential Careers

Outside Sales Representative - Weekend work Job at Confidential Careers

 ...| Full-Time Compensation: 100% Commission | $120K+ OTE (On-Target Earnings) Industry: Storm Restoration Roofing Why Rocky...  ...earn what youre worth? Comfortable working evenings and weekends if needed? Open to mentorship and personal growth? Physically... 

Randstad USA

Customer Service Representative Job at Randstad USA

 ...Training hours: Monday through Friday 8:30am-5:00pm Hybrid, remote Monday/ Friday, on site Tuesday/Wednesday/Thursday for training...  ...Core Responsibilities Serves as the initial point of contact for clients. Responds to requests for investment, fund, and account... 

Davita Inc.

COO for Private Bank US Investment Products - Director Job at Davita Inc.

Job Description: Job Title: COO for Private Bank US Investment ProductsCorporate Title: DirectorLocation: New York, NYOverviewAs Chief Operating Officer for the US Private Bank, Investment Products, you will work with various stakeholders across the investment product... 

Amergis

Licensed Marriage and Family Therapist (LMFT) Job at Amergis

 ...Psychology, Counseling or Social Work,Family Therapy preferred Licensed as a Professional Counselor, Marriage and FamilyTherapist (LMFT) as required by state regulations and/or contractspecifications One (1) year of experience in counseling preferred Current CPR... 

United States Army

Intelligence Analyst Job at United States Army

Intelligence Analyst Job Overview: We are currently seeking a highly motivated and detail-oriented individuals to join our team. You will play a crucial role in supporting our decision-making processes by providing insightful analysis of various data sources. Your new...