22 workers compensation claims representative 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 Disability Representative Sr 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 payments/approvals and adjustments, medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations; coordinates investigative efforts, thoroughly reviews contested claims,...

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:     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: 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:     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: (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....

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...

Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity As a Sr. Auto Appraiser – Field, within defined guidelines and framework, will be responsible for the investigation, negotiation, evaluation and appraisal of vehicle damage claims for both repairable and total loss vehicles to ensure estimate accuracy in compliance with state laws and regulations. Accountable for delivering...

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: Primarily responsible for evaluation, approval, completion, and processing of mail audits and reviewing phone audits 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, TPA representatives, and other premium audit staff, as well as agents, attorneys, NCCI / regulatory bureaus, and policyholders. Respond to telephone, mail, or email inquiries providing direct customer service to internal and external customers related to an audit and other policy concerns. PRIMARY RESPONSIBILITIES: •   Analyze, research, approve, complete and process mail audits. •   Analyze, research, approve, complete, and process the following audit adjustment types: waive, mail, and phone audits.  When an adjustment is denied, notify the parties involved.  •   Make necessary customer contacts to an insured,...

The Client Manager Associate, Premier Market will assume overall responsibility for managing a client book of business in the 2-99 life space. They will be responsible for persistency, growth, and profitability of this book through relationship development with clients, brokers, and key Guardian internal partners. These partners include Underwriting, Sales Support, Service and Claims. This position will also directly work with Sales Representatives to uncover opportunities to add additional lines of coverage to existing business. The Client Manager Associate is directly and/or indirectly accountable for activities associated with renewing plans (plan retention) and adding new lines of coverage (“add issue”) including, but not limited to, generating plan options and quotes for additional lines of coverage. The individual will proactively evaluate their existing book of business for add issue opportunities, as well as handle incoming renewal and negotiation requests. A...

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 Associate - Workers Compensation 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?   Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.  Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected...

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 Financial Representative 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 Dubuque, IA   : 4141 Westmark Drive, Dubuque, IA 52002 Eden Prairie, MN  : 11000 Prairie Lakes Drive Eden Prairie, MN 55344  Chicago, IL : 175 W. Jackson Blvd. 12th Fl. Chicago IL 60604 Dublin, OH : 5500 Glendon...

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 Financial Representative 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:  To calculate employee benefit overpayments; and to obtain reimbursements from overpaid disability and worker's compensation cases. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Ensures compliance with established...