Claims Representative - Med Only | Jurisdiction: Multi State | Licensing: Home State Required (Hybrid)

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 Representative - Med Only | Jurisdiction: Multi State | Licensing: Home State Required (Hybrid)

Are you looking for an impactful job requiring no prior experience that offers an opportunity to develop a professional career?

• 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. 

PRIMARY PURPOSE OF THE ROLE: To analyze Medical Only 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.

OFFICE LOCATION: Candidates who reside within 25 miles of a Sedgwick office will follow a hybrid work schedule, with 2 days in the office and 3 days working from home. Candidates residing outside of the 25-mile radius may be considered for a fully remote/work-from-home arrangement.

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.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.  

• Negotiating settlement of claims within designated authority.  

• Communicating claim activity and processing with the claimant and the client.  

• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner. 

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: Multi State

Licensing: Home State 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

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

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

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 ($40,524.00 - $56,734.00 USD Annual). 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.

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.