Claims Associate - Work Compensation Medical Only | Jurisdiction: CO, UT, WA, OR and TN | Licensing: TX/FL preferred (Plano, TX Remote)

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 - Work Compensation Medical Only | Jurisdiction: CO, UT, WA, OR and TN | Licensing: TX/FL preferred (Plano, TX Remote)

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 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?  To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.

PRIMARY PURPOSE OF THE ROLE: We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

OFFICE LOCATION: This role is designated as an on-site position located in our Plano, Texas Sedgwick office. Candidates must reside within a 25‑mile radius of the Plano office.
Individuals residing outside of the 25‑mile radius will be considered for a work‑from‑home (remote) arrangement.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• 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).

QUALIFICATIONS

Education and Licensing

High school diploma or GED required. Licenses as required.

Experience

One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.

Jurisdiction Knowledge: CO, UT, WA, OR  and TN

Licensing: TX/FL preferred

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.

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.