Workers Compensation Claims Representative | NY Jurisdictional Experience Required | Dedicated Client

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

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 representative 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 organizations.  

• 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 experts to both learn from and to share your insights.  

• Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.  

• Enjoy flexibility and autonomy in your daily work, your location, and your career path.   

• Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.  

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.  

WORK LOCATIONS 

Syracuse, NY - if within commutable distance of office, hybrid schedule

Remote if outside of commutable distance of the Syracuse, NY office

PRIMARY PURPOSE OF THE ROLE To analyze Workers Compensation Lost-Time claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. 

ESSENTIAL RESPONSIBLITIES MAY INCLUDE 

• 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. 

QUALIFICATIONS 

Education & Licensing: High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. 

Experience: 2 years of claims management experience or equivalent combination of education and experience required. 

Jurisdiction Knowledge: NY

Licensing: not required

TAKING CARE OF YOU  

• Flexible work schedule.  

• Referral incentive program.  

• Opportunity to work in an agile environment.

• Career development and promotional growth opportunities.  

• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one. 

WORK ENVIRONMENT REQUIREMENTS INCLUDE  
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

Auditory/Visual: Hearing, vision and talking 

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 (60-70K). 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.

#claimsexaminer #claims #hybrid #LI-REMOTE

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.