63 workers compensation jobs found

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 Examiner - Workers Compensation | Jurisdiction: Multi State | Licensing: TX/FL or Home State preferred (Remote) 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?      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...

SUMMARY:  Primarily responsible for the following:  Authority to evaluate which submitted vendor physical and phone audits and decide which require further analysis; approval, completion and processing mail audits; processing adjustments, and reviewing phone and physical audits requiring further review in a multi-functional business unit.  Provides direct customer service via phone, fax, and e-mail to internal and external customers including, but not limited to; Business Development Consultants and Service Center representatives, Finance, and other Premium Audit staff, as well as agents, attorneys, NCCI / regulatory bureaus, and policyholders. PRIMARY RESPONSIBILITIES: •   Actively engages in the identification of solutions for multiple or cross-functional business areas.  Has an understanding of the direction of the overall industry and evaluates the related impact. •   Evaluate and decide in a timely manner which vendor audits submitted require further review and provide...

SUMMARY:  Primarily responsible for scheduling audit appointments for Premium Auditors. Responsible for the Premium Technician Review OnBase queue and triages incoming phone calls to Premium Audit Department. Responsible for evaluation, approval, completion and processing of basic mail audits and estimating, in a multi functional business unit for a single state or states with similar rules. Provides technical assistance via phone, fax, and e-mail to internal and external customers including, but not limited to; Business Development Consultants and Service Center Representatives, Finance, and other Premium Audit staff, as well as agents, attorneys, NCCI/regulatory bureaus, and policyholders. EMPLOYMENT QUALIFICATIONS: A. EDUCATION REQUIRED:  Minimum 12 credit hours of coursework in Accounting, Business, Insurance, Finance or related field and progress towards or completion of Insurance Institute of America (IIA) or other insurance-related designation(s) such as an Associate in...

SUMMARY: This role will focus on maintenance of our incoming workload, issue resolution and first report of injury (FROI) issues.   This position determines jurisdiction for entry of first notice of injury (FNOI) from multiple sources and distributes to the proper destination.   Enters and supports priority and special requests, including correcting newly-created claims.     ESSENTIAL DUTIES AND RESPONSIBILITIES  include the following. Other duties may be assigned. Identifies jurisdiction, date of injury and special/additional handling items; researches and re-indexes non-new claim submissions to route to appropriate handling.  Receives incoming general new claims calls for all entities; backup for ACD calls in the event of telephone system shutdown. Makes changes, corrections and updates on newly created and/or existing claims or submissions as well as guiding end-users on process techniques in various applications. May serve as a resource regarding...

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 Disability Representative Sr Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence: Southfield, MI : 300 Galleria Officentre Southfield MI 48034 PRIMARY PURPOSE : Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely...

  SUMMARY:     This is the entry level professional claim handler. Handles medical only and indemnity benefits.  Exercises some discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority.    RESPONSIBILITIES/TASKS: Verifies workers’ compensation coverage of employers and injured employees.   Determines compensability under workers’ compensation by thorough investigation of the claim.   Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits. Facilitates return to work for the injured employee. Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure. Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies. Manages medical bills...

SUMMARY:     Claim Representative I:  This is the entry level professional claim handler. Handles medical only and indemnity benefits. Exercises some discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority.    Claim Representative II:  This is the intermediate level of the claim handler career path. Handles moderate difficult claims. Exercises progressively more discretion in the determination of compensability of claims. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority.    Claim Representative III:  This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May handle large, more complex customers requiring high touch, labor intensive claim service. Considers many factors...

SUMMARY:   Primarily responsible for expediting agent issues by analyzing internal business factors to produce immediate solutions. Assists agents with inquiries related to underwriting rules, procedures, regulations, and Audit issues. Mentors Renewal Specialists with complex agency/insured questions and policy information. Reviews policy structures to determine if changes need to be made to stay in compliance with bureau rules and regulations. Trains new Renewal Specialists. Provides customer service to agencies and policyholders related to complex inquiries, policy, and audit information. Contacts include state rating bureaus, Business Development Consultants, Business Development Directors, Service Center Managers, Underwriting Technical Advisor,  Service Center staff, Finance Department, Claims Department, agents and policyholders.      PRIMARY RESPONSIBILITIES:  Demonstrated ability to analyze and examine agent issues to resolve them immediately through completing...

SUMMARY: Level I is in a learning capacity and will progress to the senior level when the incumbent qualifies and is  able to provide coverage and assistance across all primary responsibilities and focus areas  independently. This job is primarily responsible for products and services underwritten by the Enterprise that require  manual processes due to the complex nature of the request or system limitations. Performs in-house  collection activity that ultimately determines financial resolution of delinquent funds owed to the  Enterprise. Services, bills and manages tasks related to “specialty” (i.e. Loss Sensitive, AccuPremium)  business underwritten by the Enterprise. Calculates commission owed to agencies on a monthly basis  and handles all servicing related to agency commissions. Contacts include: Enterprise employees,  agents and policyholders, external collection agencies, NCCI and legal representatives.  PRIMARY RESPONSIBILITIES:  • Maintains in-depth knowledge of policy...

SUMMARY: Responsible for performing virtual and field audits in a multi-functional business unit. Reviews accounting and financial information, as well as, the business operations, to determine appropriate exposures and classifications for policyholders’ employees and subcontractors. Provide assistance with training, development and mentoring of the Premium Audit staff.  This position involves physical audits in addition to virtual audits and requires travel within the assigned market/territory. Residency within or in close proximity to the designated market is required to support job responsibilities. RESPONSIBILITIES/TASKS: Performs virtual and in person field audits. Collects all pertinent data and documents needed to calculate policyholder’s premium liability. Interviews policyholders to obtain further information concerning premiums, e.g. payroll and personnel records, and communicates completed audit information with contact and ensures...

SUMMARY:  Provider Relations Specialist I Responsible for servicing internal and external customers who contact AF Group via the ACD phone line. Responsible for providing quality, consistent and accurate medical payment information to internal and external customers.  Provider Relations Specialist II Responsible for analyzing billings including outpatient hospital and multiple surgeries by utilizing our Medical Bill Review (MBR) software and reference library to determine appropriateness of codes and excessive charges. Responsible for making coding determinations according to state rules and regulations.  PRIMARY RESPONSIBILITIES:  PRIMARY RESPONSIBILITIES: Provider Relations Specialist I •    Utilizes ACD phone lines to manage incoming calls and inquiries. •    Provides high level of customer service for all internal or external customers thru telephonic, email and fax. •    Demonstrates dependable work ethic. •    Manages confidential client information with discretion and good...

SUMMARY:  Provider Relations Specialist I Responsible for servicing internal and external customers who contact AF Group via the ACD phone line. Responsible for providing quality, consistent and accurate medical payment information to internal and external customers.  Provider Relations Specialist II Responsible for analyzing billings including outpatient hospital and multiple surgeries by utilizing our Medical Bill Review (MBR) software and reference library to determine appropriateness of codes and excessive charges. Responsible for making coding determinations according to state rules and regulations.  PRIMARY RESPONSIBILITIES:  PRIMARY RESPONSIBILITIES: Provider Relations Specialist I •    Utilizes ACD phone lines to manage incoming calls and inquiries. •    Provides high level of customer service for all internal or external customers thru telephonic, email and fax. •    Demonstrates dependable work ethic. •    Manages confidential client information with discretion and good...

Plans and delivers safety/risk management services to insured customers and internal associates. We are currently seeking a risk control professional that is technically proficient, self-motivated and results driven to fill an open position within our East Shared Services division. You must be able to conduct comprehensive safety and risk management assessments, provide our Underwriting teams with a strong analytical opinion of risk to support our goal of profitable growth within variety of middle to large premium market segment for Dealerships, Construction, Manufacturing, Wholesale Trade, Retail, Commercial Real Estate and Service industries.  In addition, the successful candidate will develop close relationships with our agents and policyholders, conducting selected safety seminars and training, to build the value-added service that Sentry is known for. The ideal candidate will be based in the suburbs west of Detroit (Wayne, Livonia, Farmington Hills, etc.) with good...

SUMMARY:     The Medical Only Claims Specialist I is an entry level claims role. The incumbent is expected to be proficient with the Claims unit, policies, processes, procedures, and terminology.      The Medical Only Claims Specialist II is an experienced level claims role. The incumbent is expected to perform at a high level with minimum supervision.     Primarily responsible for the investigation and management of workers’ compensation claims. Conducts a 1 to 3-point contact on the managed claims, which is dependent on either the facts of the case or the claim type; determines compensability of claims, manages the medical treatment program, and assists in the return-to-work process. This includes calling and discussing potential claim activity and work-related injuries with policyholders, claimants, providers, attorneys, agents, and state agencies. Trains and mentors other team members. Provides backup support to other...

SUMMARY:   T his position will provide legal assistance to the attorneys representing the Enterprise in all aspects of legal case preparation and file management including legal research; analyzing law sources such as statutes, judicial decisions, legal articles and legal codes; drafting complex documents; contacting and interviewing clients, attorneys and witnesses; and collecting documents and information relevant to cases. The position requires you to perform expected tasks with minimal supervision.   RESPONSIBILITIES/TASKS:   Review and summarize medical and other records and prepare summaries of relevant information. Interview witnesses to gather information or confer with personnel in other departments and outside the organization while performing research or other legal responsibilities. Assist attorneys with complex caseload research, subject and topic research, and briefings of court cases. Provide advice and guidance on a variety of...

SUMMARY: (Brief 3-5 sentence paragraph outlining the main purpose of the job)     The Medical Only Claims Specialist I is an entry level claims role. The incumbent is expected to be proficient with the Claims unit, policies, processes, procedures, and terminology.      The Medical Only Claims Specialist II is an experienced level claims role. The incumbent is expected to perform at a high level with minimum supervision.     Primarily responsible for the investigation and management of workers’ compensation claims. Conducts a 1 to 3-point contact on the managed claims, which is dependent on either the facts of the case or the claim type; determines compensability of claims, manages the medical treatment program, and assists in the return-to-work process. This includes calling and discussing potential claim activity and work-related injuries with policyholders, claimants, providers, attorneys, agents, and state agencies....

SUMMARY: (Brief 3-5 sentence paragraph outlining the main purpose of the job)   This is an entry-level position. This position leads to a Medical Only Claims Specialist I and is expected to last up to 12 months. Upon completion of the training plan the incumbent is expected to be proficient with the Medical Only Claims policies, processes, procedures, and terminology related to the job. In addition, the incumbent will be proficient in the job responsibilities and tasks of the Medical Only Claims Specialist I position description. The incumbent will be evaluated on their progress and successful completion of the training plan each quarter. Upon satisfactory completion, the incumbent will be eligible for the Medical Only Claims Specialist I position.  Medical Only Claims Associate will work with all members of the team and may receive direction, support, and instruction from the Manager or Medical Only Claims Specialists depending on the assignment....

SUMMARY: (Brief 3-5 sentence paragraph outlining the main purpose of the job)   This is an entry-level position. This position leads to a Medical Only Claims Specialist I and is expected to last up to 12 months. Upon completion of the training plan the incumbent is expected to be proficient with the Medical Only Claims policies, processes, procedures, and terminology related to the job. In addition, the incumbent will be proficient in the job responsibilities and tasks of the Medical Only Claims Specialist I position description. The incumbent will be evaluated on their progress and successful completion of the training plan each quarter. Upon satisfactory completion, the incumbent will be eligible for the Medical Only Claims Specialist I position.  Medical Only Claims Associate will work with all members of the team and may receive direction, support, and instruction from the Manager or Medical Only Claims Specialists depending on the assignment....

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 Disability Representative Disability Representative Our teams thrive together! We collaborate in person and embrace a flexible hybrid work style. To join us, you’ll need to live near our dynamic Centers of Excellence📍 Southfield, MI. 3 00 Galleria Officentre Southfield MI 48034​. ✨ What we offer: A stable, consistent work environment —both in-office and virtual A comprehensive training program to help you support employees and customers from some of...

SUMMARY: (Brief 3-5 sentence paragraph outlining the main purpose of the job)     The Medical Only Claims Specialist I is an entry level claims role. The incumbent is expected to be proficient with the Claims unit, policies, processes, procedures, and terminology.      The Medical Only Claims Specialist II is an experienced level claims role. The incumbent is expected to perform at a high level with minimum supervision.     Primarily responsible for the investigation and management of workers’ compensation claims. Conducts a 1 to 3-point contact on the managed claims, which is dependent on either the facts of the case or the claim type; determines compensability of claims, manages the medical treatment program, and assists in the return-to-work process. This includes calling and discussing potential claim activity and work-related injuries with policyholders, claimants, providers, attorneys, agents, and state agencies....