Are you looking for an impactful job that offers an opportunity to develop a professional career?

• This role is hybrid 2 days in the Sacramento, CA Sedgwick office and 3 days' work at home*
• Career development and promotional growth opportunities through increasing responsibilities
• A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional needs

PRIMARY PURPOSE OF THE ROLE: The Claims Services Associate is an important part of the services provided as they work closely with the Workers’ Compensation Program Managers to receive, review, and document California workers’ compensation information as directed. The Associate communicates regularly when needed with medical facilities, third-party administrators, clients, and staff. With the Associate’s skills and knowledge, the Associate will review documents and other third-party administrator’s claims system to make recommendations when needed to staff that will move workers’ compensation claims toward resolution.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Provides initial research/data collection on claims file.
• Performs file audits according to jurisdictional standards as directed by state, carrier, or client.
• Reviews prior audit results, settled files, or files with no activity and identifies exceptions.
• Coordinates file retrieval and gathers data for submittal to management.
• Communicates with claim examiners to correct identified deficiencies by provides corrected payment amount and instructions regarding necessary state form filing.
• Monitors correction of audit exceptions ensuring completion and assists with filing of state forms and submitting payments as necessary.
• Researches exceptions on the state's quarterly compliance report and provides detailed response to management identifying trends in audit exceptions.
• Reviews and updates notes/diaries in claims management system as instructed.
• Coordinates jurisdictional training on state specific tools.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).

QUALIFICATION

Education & Licensing
High school diploma or GED required.

Experience
Two (2) years of claims experience or equivalent combination of education and experience required.

Skills & Knowledge

• Knowledge of state workers' compensation statute
• Proficient math skill
• Skilled with Excel spreadsheets
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

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

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 $28.37 to $32.43 USD hourly. 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. 

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.