[Remote] Workers Compensation Consultant - Level 1
Note: The job is a remote job and is open to candidates in USA. Sedgwick is a recognized leader in the financial services and insurance sector, dedicated to supporting people facing unexpected challenges. They are seeking a Workers Compensation Consultant - Level 1 to analyze and manage less complex workers compensation claims, ensuring compliance and effective communication with stakeholders.
Responsibilities
- Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision
- Supports other claims representatives, examiners and leads with larger or more complex claims as necessary
- Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency
- Communicates claim action/processing with claimant, client and appropriate medical contact
- Ensures claim files are properly documented and claims coding is correct
- May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims
- Maintains professional client relationships
- Performs other duties as assigned
- Supports the organization's quality program(s)
Skills
- High school diploma required
- One (1) year of general office experience or equivalent combination of education and experience required
- Excellent oral and written communication 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 Performance Competencies
- Claims industry experience preferred
- Paralegal expertise for handling claims, appeals, and compliance matters
- Strong knowledge of workers' compensation legislation and health & safety standards
- Proven ability to manage complex claims processes and collaborate with stakeholders
- Experience in HR leave programs, disability case management, and policy interpretation
Company Overview