Claims Adjuster Workers Compensation
Company: Sedgwick Claims Management Services, Inc
Location: Ontario
Posted on: January 12, 2021
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Job Description:
Claims Adjuster - Workers CompensationIF YOU CARE, THERE'S A
PLACE FOR YOU HEREFor a career path that is both challenging and
rewarding, join Sedgwick's talented team of 21,000 colleagues
around the globe. Sedgwick is a leading provider of
technology-enabled risk, benefits and integrated business
solutions. Taking care of people is at the heart of everything we
do. Millions of people and organizations count on Sedgwick each
year to take care of their needs when they face a major life event
or something unexpected happens. Whether they have a workplace
injury, suffer property or financial loss or damage from a natural
or manmade disaster, are involved in an auto or other type of
accident, or need time away from work for the birth of a child or
another medical situation, we are here to provide compassionate
care and expert guidance. Our clients depend on our talented
colleagues to take care of their most valuable assets -- their
employees, their customers and their property. At Sedgwick, caring
counts--. Join our team of creative and caring people of all
backgrounds, and help us make a difference in the lives of
others.For nearly 50 years, Sedgwick has been helping employers
answer virtually every question there is about workers'
compensation. We have experience in nearly every type of industry,
in every region, providing the broadest range of programs and
services.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.QUALIFICATIONEducation & LicensingBachelor's degree from
an accredited college or university preferred.ExperienceFour (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 skills*
Good interpersonal skills* Ability to work in a team environment*
Ability to meet or exceed Service ExpectationsWORK ENVIRONMENTWhen
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 deadlinesPhysical: Computer keyboarding, travel as
requiredAuditory/Visual: Hearing, vision and talkingNOTE: 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 Employerand aDrug-Free
Workplace**Must currently meet the requirements for designation
under AB1262, or have California Self-Insurers Certificate (SIP) or
AB1262 California Experienced Examiner Designation. WCCA, WCCP
preferred.#LI-TS #monster#hiringnow #stillhiring
Keywords: Sedgwick Claims Management Services, Inc, Ontario , Claims Adjuster Workers Compensation, Other , Ontario, California
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