Claims Associate - Workers Compensation (100% Onsite)

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.

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Claims Associate - Workers Compensation (100% Onsite)

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?   

• 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.  

PRIMARY PURPOSE OF THE ROLE To oversee components of the Nevada Workers’ Compensation claims process, ensuring claim activities are completed accurately and within applicable timeframes. This role provides focused oversight of specific claim functions.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE [

• Tracks and reports on timeliness of key aspects of the Workers’ Compensation claims process, including denials, settlements, required timeframes, payments, filings, and other assigned claim activities.
• Monitors claims to ensure required actions, payments, documentation, and filings are completed accurately and within established timeframes.
• Provides oversight of specific portions of the claims process to help ensure compliance with Nevada Workers’ Compensation requirements and internal standards.
• Reviews claim activity and documentation to identify outstanding or time-sensitive items requiring action or follow-up.
• Coordinates with claims examiners, leadership appropriate parties to support timely completion of claim activities.
• Assists with the preparation, review, and submission of required claim documentation and regulatory filings.
• Monitors the timely processing of benefits and payments and follows up on outstanding items as appropriate.
• Supports the handling of denials and settlements by ensuring required documentation, notices, approvals, and related activities are completed within applicable timeframes.
• Identifies potential delays, missing information, or process issues and works with the appropriate parties toward resolution.

ADDITIONAL FUNCTIONS AND RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization’s quality and compliance programs.
• Assists with additional Workers’ Compensation activities as business needs require.

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. Must possess or be able to obtain the applicable Nevada Workers’ Compensation claims certification/credential required for the position.

Experience: 1 years of claims management experience or equivalent combination of education and experience required. Experience supporting or managing claim activities involving regulatory timeframes, payments, filings, denials, settlements, or similar claim functions strongly preferred.

TAKING CARE OF YOU  

• Flexible work schedule.  

• Referral incentive program.  
• 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, travel as required

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 ($17.00 - $25.00). 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.